摘要
目的观察星状神经节阻滞(SGB)对烧伤患者术后应激、炎症反应和认知功能(POCD)的影响.方法选取2017年1月到2019年12月行皮肤移植术的烧伤患者60例,随机分为观察组和对照组,各30例.观察组患者采用全身麻醉同时行SGB,对照组患者仅采用全身麻醉,记录两组患者麻醉诱导前(T0)、手术开始2h(T1)、手术完成时(T2)、术后12h(T3)和术后24h(T4)的心率(HR)、中心静脉压(CVP)、有创平均动脉测压(IMBP)、SpO_(2)和呼吸(RR)等血流动力学指标,采用酶联免疫吸附(ELISA)法检测血浆超敏C反应蛋白(hs-CRP)、皮质醇(Cor)、IL-6和TNF-α水平,采用全自动生化仪检测血糖浓度,采用MMSE法评价两组患者POCD发生率.结果观察组在T1、T2和T3时间点hs-CRP、Cor、IL-6和TNF-α的表达水平均明显高于对照组,在T1和T2时间点血糖的水平明显高于对照组,差异均有统计学意义(P<0.05);观察组术后1天和3天简易精神状态评价量表(MMSE)评分明显高于对照组,差异有统计学意义(P<0.05),术后1天观察组患者POCD发生率明显低于对照组,差异有统计学意义(P<0.05).结论SGB技术对烧伤患者行全身麻醉下皮肤移植术过程中应激和炎症反应的控制方面有积极意义,同时对患者POCD障碍具有明显的缓解作用.
Objective To observe the effect of stellate ganglion block(SGB)technique on postoperative stress response and postoperative cognitive function(POCD)of burn patients.Methods A total of 60 burn patients who were admitted to Meizhou Hospital of Traditional Chinese Medicine from January 2017 to December 2019 were selected and randomly divided into observation group(30 cases)and control group(30 cases).Patients in the observation group received general anesthesia and SGB at the same time,and patients in the control group only received general anesthesia.The heart rate(HR),central venous pressure(CVP),invasive mean arterial pressure(IMBP),SpO_(2) and respiration(RR)of the two groups of patients before induction of anesthesia(TO),2 h after the start of the operational),the time when the operation was completed(T2),12 h after the end of the operation(T3),and after the end of the operation(T4)were recorded,enzyme-linked immunosorbent(ELISA)method was used to detect plasma hypersensitive C-reactive protein(hs-CRP),cortisol(Cor),IL-6 and TNF-α levels,automatic biochemical analyzer was used to detect blood glucose concentration,and MMSE method was used for evaluation evaluating the incidence of POCD in the two groups.Results The expression levels of hs-CRP,Cor,IL-6 and TNF-α in the observation group at T1,T2 and T3 time points were significantly higher than those of the control group,and the blood glucose expression levels at T1 and T2 time points were significantly higher than those of the control group,all were statistically significant(P<0.05).The observation group's MMSE scores at 1 day and 3 days after surgery were significantly higher than those of the control group,and the difference was statistically significant(P<0.05).The incidence of POCD in the observation group at 1 day after surgery was significantly lower than that of the control group,the difference was statistically significant(P<0.05).Conclusion The SGB technology is of positive significance for the control of stress and in flammation during the operation of burn patients undergoing skin transplantation under general anesthesia,and at the same time has a significant relieving effect on patients with POCD disorders.
出处
《浙江临床医学》
2022年第1期117-119,共3页
Zhejiang Clinical Medical Journal
关键词
星状神经节阻滞
烧伤
应激反应
术后认知功能
Stellate ganglion block
Bums
Stress response
Postoperative cognitive function
