本文選題：H型高血壓　切入點(diǎn)：星狀神經(jīng)節(jié)　出處：《山東醫(yī)藥》2017年17期

【摘要】：目的觀察星狀神經(jīng)節(jié)阻滯(SGB)對H型高血壓患者腹腔鏡下膽囊切除術(shù)圍術(shù)期血流動力學(xué)及腦代謝的影響。方法選取H型高血壓需要行腹腔鏡下膽囊切除術(shù)患者60例,采用隨機(jī)單盲法分為觀察組和對照組各30例。兩組均于麻醉誘導(dǎo)前30 min在C6橫突根部行藥液注射,觀察組注射0.8%利多卡因8 mL行SGB,對照組注射0.9%氯化鈉8 mL。分別于麻醉誘導(dǎo)前(T_0)、氣管插管時(T_1)、氣腹建立時(T_2)、膽囊切除時(T_3)、拔管后蘇醒時(T_4)監(jiān)測血流動力學(xué)指標(biāo):平均動脈壓(MAP)、心率(HR)、心率平均動脈壓乘積(HR·MAP)。于T_0、T_3、T_4時檢測腦氧代謝指標(biāo):動脈血氧飽和度(SaO_2)、動脈血氧分壓(PaO_2)、頸內(nèi)靜脈球部血氧飽和度(SjvO_2)、頸內(nèi)靜脈球部血氧分壓(PjvO_2),計算橈動脈-頸內(nèi)靜脈球部血氧含量差值(Da-jvO_2)、腦氧攝取率(CEO_2);腦糖及乳酸代謝指標(biāo):糖、乳酸代謝指標(biāo),動脈血糖濃度(Glua)、頸內(nèi)靜脈球部血糖濃度(Glujv)、動脈血乳酸濃度(Lac)、頸內(nèi)靜脈球部學(xué)乳酸濃度(Ljvc),計算動靜脈血糖含量差(Da-jvGlu)、動靜脈乳酸濃度差(Da-jv Lac)。結(jié)果 T_1~T_4時,觀察組MAP、HR、HR·MAP低于對照組(P均0.05)。T_3、T_4時,觀察組SjvO_2高于對照組,Da-jvO_2、CEO_2低于對照組(P均0.05)。T_3、T_4時,觀察組Glua、Glujv、Da-jvGlu低于對照組(P均0.05)。術(shù)后觀察組POCD發(fā)生率低于對照組(P0.05)。結(jié)論 SGB可減少H型高血壓患者圍術(shù)期機(jī)體應(yīng)激引起的循環(huán)波動,降低患者腦氧和能量代謝。
[Abstract]:Objective to observe the effect of stellate ganglion block (SGB) on hemodynamics and brain metabolism in patients with H type hypertension undergoing laparoscopic cholecystectomy. Two groups were randomly divided into two groups: the observation group (n = 30) and the control group (n = 30). The two groups were injected with liquid at the root of the transverse process of C6 30 min before anesthesia induction. The observation group was injected with 0.8% lidocaine 8 mL for SGBand the control group was injected with 0.9% sodium chloride 8 mL. Before anesthesia induction, T _ (0), T _ (1), T _ (1), T _ (2), T _ (3), T _ (3) and T _ (4), respectively, were observed before anesthesia induction, respectively, when pneumoperitoneum was established, when cholecystectomy was performed, and when T _ (4) was recovered after extubation. Mean arterial pressure (MAPP), heart rate (HRP), mean arterial pressure (HRP), HR MAPP (HR MAPP). The indexes of cerebral oxygen metabolism were measured at T _ 0 / T _ 3 / T _ 4. The indexes of cerebral oxygen metabolism were as follows: arterial oxygen saturation (SAO _ 2), Pao _ (2), SjvO _ (2), SjvO _ (2), PjvO _ (2) in internal jugular venous bulb, and PjvO _ (2) in internal jugular vein. The difference of blood oxygen content in the bulbar of radial artery and internal jugular vein is Da-jvO2P, cerebral oxygen uptake rate is higher than that of CEO 2s. The indexes of lactate metabolism, arterial blood glucose concentration, jugular venous blood glucose concentration, arterial blood lactate concentration and lactic acid concentration in internal jugular vein were determined. The HRHR MAP of the observation group was lower than that of the control group (P 0.05). The SjvO_2 of the observation group was higher than that of the control group (Da-jvO _ 2CEO _ 2), and it was lower than that of the control group (0.05% 路T _ 3 / T _ 4), and the SjvO_2 of the observation group was higher than that of the control group (0.05% 路T _ 3 / T _ 4). The incidence of POCD in the observation group was lower than that in the control group (P < 0.05). Conclusion SGB can reduce the circulatory fluctuation induced by perioperative stress and decrease the cerebral oxygen and energy metabolism in patients with H type hypertension.
【作者單位】： 西南醫(yī)科大學(xué)附屬中醫(yī)醫(yī)院;重慶市涪陵中心醫(yī)院;
【基金】：四川省應(yīng)用基礎(chǔ)研究計劃項(xiàng)目(14JC0173)
【分類號】：R614

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