超声引导下星状神经节阻滞对胃肠道手术患者围术期炎症反应及术后胃肠道功能恢复的影响

发布时间：2018-06-29 10:04

本文选题：胃肠道手术 + 星状神经节阻滞　；参考：《浙江大学》2017年硕士论文

【摘要】：目的:本研究的目的是探讨超声引导下单侧星状神经节阻滞(stellate ganglion block,SGB)对胃肠道手术患者围术期炎症反应及术后胃肠道功能恢复的作用。方法:本课题前瞻性地纳入了 69名行胃肠道手术患者,按1:2比例随机分组。最终,SGB组有18例患者、对照组有42例患者完成研究并纳入统计分析。在超声引导下,SGB组于左侧第六颈椎水平以7ml 0.5%罗哌卡因行星状神经节阻滞,对照组于同一部位在星状神经节处注射7ml生理盐水。采集两组病人SGB前(0h)、SGB后2h、SGB后4h及SGB后24h的外周血,分析比较两组病人这四个时间点的TNF-α、IL-1β、IL-6等细胞因子水平。同时采集SGB前和SGB后第一天的白细胞、血小板、胆红素、肌酐水平等临床数据以及患者术后肠鸣音和肛门/造口排气的恢复时间。结果:SGB组的TNF-α水平在SGB后2h、4h及IL-1β水平在SGB后2h、24h明显低于对照组(P0.05),IL-6水平与对照组无明显差异。SGB组术后白细胞计数上升水平小于对照组(SGB组平均升高水平为4.05±4.03×109/LVS对照组平均升高水平为6.37±3.35×109/L,P0.05)。两组的胆红素、肌酐及血小板计数水平无明显差异。在术后胃肠道功能恢复方面,SGB组术后肠鸣音恢复时间(SGB组46.22±31.02小时VS对照组72.27±35.70小时,P0.05)及肛门/造口排气时间(SGB组65.78±33.93小时VS对照组94.40±43.38小时,P0.05)明显低于对照组。结论:对于胃肠道手术患者,SGB可抑制TNF-α、IL-1β等细胞因子的表达,降低术后白细胞水平的增幅,以及缩短术后肠鸣音和肛门/造口排气的恢复时间。提示SGB有助于改善此类患者的围术期炎症反应,并促进术后胃肠道功能的恢复。
[Abstract]:Objective: to investigate the effect of (stellate ganglion block guided by ultrasound on perioperative inflammatory reaction and gastrointestinal function recovery in patients undergoing gastrointestinal surgery. Methods: 69 patients undergoing gastrointestinal surgery were prospectively divided into groups at 1:2. Finally, there were 18 patients in the SGB group and 42 patients in the control group. 7ml 0.5% ropivacaine planetary ganglion was used to block the sixth cervical vertebra in the SGB group under the guidance of ultrasound, while the control group was injected with 7ml saline at the stellate ganglion at the same position. The levels of cytokines such as TNF- 伪 IL-1 尾 and IL-6 were collected from peripheral blood of two groups of patients before (0 h), 2 h after SGB and 24 h after SGB, respectively. At the same time, the clinical data of white blood cells, platelets, bilirubin and creatinine were collected before and on the first day after SGB. Results the levels of TNF- 伪 and IL-1 尾 in the control group were significantly lower than those in the control group (P0.05). The increase level of leukocyte count in the SGB group was lower than that in the control group (4.05 卤4.03 脳 10 9 / LVS) (the average level of increase was 4.05 卤4.03 脳 10 9 / LVS) in the control group (4. 05 卤4. 03 脳 10 9 / LVS). The average elevation was 6.37 卤3.35 脳 10 ~ 9 / L (P0.05). There was no significant difference in bilirubin, creatinine and platelet count between the two groups. The recovery time of postoperative bowel sounds in SGB group (46.22 卤31.02 hours vs control group, 72.27 卤35.70 hours, P0.05) and anal / orifice venting time (SGB group, 65.78 卤33.93 hours vs 94.40 卤43.38 hours, P0.05) were significantly lower than those in control group. Conclusion: SGB can inhibit the expression of cytokines such as TNF- 伪 and IL-1 尾, decrease the increase of leukocyte level after operation, and shorten the recovery time of bowel sound and anus / orifice exhaust. The results suggest that SGB can improve the perioperative inflammatory reaction and promote the recovery of gastrointestinal function.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

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