星状神经节阻滞与全麻插管期心血管反应

【】　目的　观察右星状神经节阻滞（R-SGB）对全身麻醉气管内插管期心血管反应的影响。　方法　2009年10-12月选取60例美国麻醉医师协会（ASA）Ⅰ、Ⅱ级择期全麻手术患者，随机分为3组。研究组于全麻诱导前15min用1%利多卡因10mL经颈6入路行R-SGB，对照组1诱导前同法注射10mL生理盐水，对照组2诱导前肌注2%利多卡因5mL。观察气管插管前后收缩压（SBP）、舒张压（DBP）、平均动脉压（MBP）、心率（HR）、心电图（ECG）、氧饱和度（SpO？2）和心率收缩压乘积（RPP）的变化。　结果　研究组各时点与进入手术室时的基础值比较，仅诱导后SBP、DBP、MBP显著降低，窥喉时HR和RPP显著升高（P<0.01）；在插管3min后已恢复至基础值。对照组1和对照组2诱导后SBP、DBP、MBP显著降低（P<0.01）；窥喉时SBP、DBP、MBP、HR、RPP均显著升高（P<0.01），并持续至插管后5min。两对照组升高的程度均显著高于研究组（P<0.05或P<0.01）。　结论　R-SGB对全麻气管插管期的心血管反应有一定抑制作用，可用于调控全麻插管期心血管不良反应。？【Abstract】　Objective　Toexploretheeffectofrightstellateganglionblock(R-SGB)oncardiovascularresponseduringendotrachealintubationunderthegeneralanesthesia.　Methods　SixtyASAⅠ-ⅡpatientswhounderwentgeneralanaesthesiabetweenOctobertoDecember2009wererandomlydividedintothreegroups.ThepatientsinthetrialgroupacceptedR-SGBbyC6routewith1%lidocaine(10mL)15minutesbeforeinductionofgeneralanesthesia;thepatientsincontrolgroup1wereinjectedwith10mLphysiologicalsalineinthesamewaybeforetheinduction;thepatientsincontrolgroup2underwenttheintramuscularinjectionof2%lidocaine(5mL)beforetheinduction.Thechangesofsystolicbloodpressure(SBP),diastolicbloodpressure(DBP),meanarterialpressure(MAP),hearrate(HR),electrocardiogram(ECG),oxygensaturation(SpO？2)andheartrate-systolicbloodpressureproduct(RPP)beforeandafterendotrachealintubationwereobservedandrecorded.　Results　Inthetrialgroup,SBP,MAP,andDBPdecreasedsignificantlyaftertheinduction;HRandRPPincreasedevidentlyatthelaryngealexposurecomparedwiththebaselinevalues(P<0.01)andrecoveredthreeminutesaftertheintubation.Inthecontrolgroup1and2,SBP,MAP,andDBPdecreasedsignificantlyafterinduction(P<0.01);SBP,MAP,DBP,HRandRPPincreasedapparentlyatthelaryngealexposurecomparedwiththebaselinevalues(P<0.01),andtheraisecontinueduntilfiveminutesafterendotrachealintubation.Thedifferenceintheraisebetweenthecontrolgroupsandthetrialgroupwassignificant(P<0.05orP<0.01).　Conclusion　R-SGBmayeffectivelyinhibitthecardiovascularresponseduringendotrachealintubationunderthegeneralanesthesiaandcanbeusedtocontrolthenegativereactionduringtheinduction.