星状神经节阻滞对H型高血压患者腹腔镜下胆囊切除术围术期循环及脑代谢的影响

发布时间：2018-03-29 07:35

本文选题：H型高血压　切入点：星状神经节　出处：《山东医药》2017年17期

【摘要】：目的观察星状神经节阻滞(SGB)对H型高血压患者腹腔镜下胆囊切除术围术期血流动力学及脑代谢的影响。方法选取H型高血压需要行腹腔镜下胆囊切除术患者60例,采用随机单盲法分为观察组和对照组各30例。两组均于麻醉诱导前30 min在C6横突根部行药液注射,观察组注射0.8%利多卡因8 mL行SGB,对照组注射0.9%氯化钠8 mL。分别于麻醉诱导前(T_0)、气管插管时(T_1)、气腹建立时(T_2)、胆囊切除时(T_3)、拔管后苏醒时(T_4)监测血流动力学指标:平均动脉压(MAP)、心率(HR)、心率平均动脉压乘积(HR·MAP)。于T_0、T_3、T_4时检测脑氧代谢指标:动脉血氧饱和度(SaO_2)、动脉血氧分压(PaO_2)、颈内静脉球部血氧饱和度(SjvO_2)、颈内静脉球部血氧分压(PjvO_2),计算桡动脉-颈内静脉球部血氧含量差值(Da-jvO_2)、脑氧摄取率(CEO_2);脑糖及乳酸代谢指标:糖、乳酸代谢指标,动脉血糖浓度(Glua)、颈内静脉球部血糖浓度(Glujv)、动脉血乳酸浓度(Lac)、颈内静脉球部学乳酸浓度(Ljvc),计算动静脉血糖含量差(Da-jvGlu)、动静脉乳酸浓度差(Da-jv Lac)。结果 T_1~T_4时,观察组MAP、HR、HR·MAP低于对照组(P均0.05)。T_3、T_4时,观察组SjvO_2高于对照组,Da-jvO_2、CEO_2低于对照组(P均0.05)。T_3、T_4时,观察组Glua、Glujv、Da-jvGlu低于对照组(P均0.05)。术后观察组POCD发生率低于对照组(P0.05)。结论 SGB可减少H型高血压患者围术期机体应激引起的循环波动,降低患者脑氧和能量代谢。
[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.
【作者单位】：西南医科大学附属中医医院;重庆市涪陵中心医院;
【基金】：四川省应用基础研究计划项目(14JC0173)
【分类号】：R614

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