全身麻醉联合超声引导下星状神经节阻滞对肩关节镜手术患者血流动力学和术后认知功能的影响

Impacts of ultrasound-guided stellate ganglion block combined with general anesthesia on hemodynamics and postoperative cognitive function in patients undergoing shoulder arthroscopic surgery

摘要:

目的 探讨全身麻醉联合超声引导下星状神经节阻滞（SGB）对肩关节镜手术患者血流动力学和术后认知功能的影响。方法 选取2024年1月－2024年6月该院收治的肩关节镜手术患者120例，随机分为全身麻醉组（n = 60，实施全身麻醉）和辅助SGB组（n = 60，实施全身麻醉联合超声引导下SGB）。比较两组患者血流动力学指标、应激指标［血清皮质醇（Cor）和白细胞介素-6（IL-6）］、术后疼痛度［采用视觉模拟评分法（VAS）评分进行评定］、生物标志物［血清基质金属蛋白酶-9（MMP-9）和神经特异性蛋白S-100β（S-100β）］水平和认知功能［采用简易智力状态检查量表（MMSE）进行评定］。结果 两组患者术中出血量和手术时间比较，差异均无统计学意义（P > 0.05）。两组患者诱导麻醉后（T₁）的平均动脉压（MAP）和心率（HR）明显低于入室时（T₀），差异均有统计学意义（P < 0.05）；手术开始时（T₂）、手术开始后30 min（T₃）和术毕时（T₄）的MAP和HR明显高于T₀时点，差异均有统计学意义（P < 0.05）；辅助SGB组T₁、T₂、T₃和T₄时点MAP和HR明显低于全身麻醉组，差异均有统计学意义（P < 0.05）。辅助SGB组术后12和24 h VAS评分明显低于全身麻醉组，差异均有统计学意义（P < 0.05）。术后12和24 h，两组患者血清Cor和IL-6水平明显高于术前1 d，但辅助SGB组血清Cor和IL-6水平明显低于全身麻醉组，差异均有统计学意义（P < 0.05）。术后24和72 h，两组患者血清MMP-9和S-100β水平明显高于术前1 d，但辅助SGB组血清MMP-9和S-100β水平明显低于全身麻醉组，差异均有统计学意义（P < 0.05）。术后3和5 d，两组患者MMSE评分明显低于术前1 d，但辅助SGB组MMSE评分明显高于全身麻醉组，差异均有统计学意义（P < 0.05）。结论 肩关节镜手术中实施全身麻醉联合超声引导下SGB，可维持术中血流动力学稳定，缓解术后应激状况，减轻疼痛，降低血清MMP-9和S-100β表达水平，提高术后认知功能。值得临床推广应用。

Abstract:

Objective To investigate the impacts of ultrasound-guided stellate ganglion block (SGB) on hemodynamics and postoperative cognitive function in patients undergoing shoulder arthroscopic surgery.Methods From January 2024 to June 2024, 120 patients undergoing shoulder arthroscopic surgery in our hospital were randomly assigned into general anesthesia group (n = 60, implementing general anesthesia) and assisted SGB group (n = 60, implementing ultrasound-guided SGB combined with general anesthesia). The intraoperative hemodynamics, postoperative stress status [serum cortisol (Cor) and interleukin-6 (IL-6)], postoperative pain level [evaluated by visual analogue scale (VAS) score], postoperative biomarkers [serum matrix metalloproteinase-9 (MMP-9) and neurospecific protein S-100β (S-100β)], and postoperative cognitive function [evaluated using the mini-mental state examination (MMSE)] were compared between the two groups.Results There was no statistically significant difference in intraoperative blood loss and surgical time between the two groups of patients (P > 0.05). After induction of anesthesia (T₁), the mean arterial pressure (MAP) and heart rate (HR) of the two groups of patients were significantly lower than when they entered the operating room (T₀), the differences were statistically significant (P < 0.05). The MAP and HR during the beginning of the surgery (T₂), 30 min after the start of the surgery (T₃), and at the end of the surgery (T₄) were higher than those at T₀, the differences were statistically significant (P < 0.05). While the MAP and HR in the assisted SGB group during T₁, T₂, T₃ and T₄ time points were lower than those in the general anesthesia group, the differences were statistically significant (P < 0.05). The VAS scores of the assisted SGB group were significantly lower than those of the general anesthesia group at 12 and 24 h after surgery, and the differences were statistically significant (P < 0.05). The levels of serum Cor and IL-6 in the two groups at 12 and 24 h after surgery were higher than those at 1 d before surgery, but the levels of serum Cor and IL-6 in the assisted SGB group were lower than those in the general anesthesia group, the differences were statistically significant (P < 0.05). The levels of serum MMP-9 and S-100β in the two groups at 24 and 72 h after surgery were higher than those at 1 d before surgery (P < 0.05), but the levels of serum MMP-9 and S-100β in the assisted SGB group were lower than those in the general anesthesia group, the differences were statistically significant (P < 0.05). The MMSE score of the two groups at 3 and 5 d after surgery were lower than those at 1 d before surgery, but the MMSE score of the assisted SGB group was higher than that of the general anesthesia group, the difference was statistically significant (P < 0.05).Conclusion The implementation of ultrasound-guided SGB during shoulder arthroscopic surgery can maintain intraoperative hemodynamic stability, obviously alleviate postoperative stress and pain, obviously reduce serum MMP-9 and serum S-100β levels, and help alleviate postoperative cognitive dysfunction. It is worthy clinical application.