超声引导下星状神经节阻滞对老年单肺通气患者肺内分流及脑氧代谢的影响

doi:10.3877/cma.j.issn.2095-8757.2024.02.005

中华老年病研究电子杂志 ›› 2024, Vol. 11 ›› Issue (02) : 20 -25. doi: 10.3877/cma.j.issn.2095-8757.2024.02.005

临床研究

超声引导下星状神经节阻滞对老年单肺通气患者肺内分流及脑氧代谢的影响

周云¹, 韩丽², 赵月², 袁晨², 杨昌建², 杨芬², 谢阳²^,^†(

)

^1. 215000　南京医科大学附属苏州医院　苏州市立医院麻醉科；215002　苏州工业园区星海医院麻醉科
^2. 215000　南京医科大学附属苏州医院　苏州市立医院麻醉科

收稿日期:2023-11-28 出版日期:2024-05-28
通信作者: 谢阳
基金资助:
江苏省自然科学基金项目(BK20180214); 上海闵行区卫生健康委员会科研项目(2023MW69)

Effects of utrasound-guided stellate ganglion block on pulmonary shunting and cerebral oxygen metabolism in elderly patients undergoing single-lung ventilation

Yun Zhou¹, Li Han², Yue Zhao², Chen Yuan², Changjian Yang², Fen Yang², Yang Xie²^,^†()

^1. Department of Anesthesiology, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou 215000, China; Department of Anesthesiology, Xinghai Hospital of Suzhou Industrial Park, Suzhou 215002, China
^2. Department of Anesthesiology, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou 215000, China

Received:2023-11-28 Published:2024-05-28
Corresponding author: Yang Xie

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引用本文：

周云, 韩丽, 赵月, 袁晨, 杨昌建, 杨芬, 谢阳. 超声引导下星状神经节阻滞对老年单肺通气患者肺内分流及脑氧代谢的影响[J]. 中华老年病研究电子杂志, 2024, 11(02): 20-25.

Yun Zhou, Li Han, Yue Zhao, Chen Yuan, Changjian Yang, Fen Yang, Yang Xie. Effects of utrasound-guided stellate ganglion block on pulmonary shunting and cerebral oxygen metabolism in elderly patients undergoing single-lung ventilation[J]. Chinese Journal of Geriatrics Research(Electronic Edition), 2024, 11(02): 20-25.

目的

观察超声引导下星状神经节阻滞（SGB）对老年单肺通气患者肺内分流和脑氧代谢的影响。

方法

选择2020年4月至2022年10月于南京医科大学附属苏州医院择期行单肺通气下胸腔手术的老年患者96例，其中48例在全身麻醉前行超声引导下通气侧SGB（SGB组），余48例不给予SGB（对照组）。在手术开始即刻（T0），双肺通气15 min后（T1），单肺通气15 min后（T2）、30 min后（T3）、60 min后（T4），以及恢复双肺通气15 min后（T5），监测并记录患者的生理指标，包括平均动脉压（MAP）和心率，并进行桡动脉血和颈内静脉球部血的血气分析，计算肺内分流量和氧合指数；同时，记录颈静脉血氧饱和度（SvO₂）和阻滞侧脑氧饱和度（rSO₂），通过公式计算脑氧耗量（Ca-vO₂）、脑氧摄取率（CERO₂）。记录与SGB相关的并发症，以及术后72 h内肺部并发症的发生情况。计量资料的比较采用t检验或重复测量方差分析，计数资料的比较采用χ²检验。

结果

最终纳入统计分析患者共93例，其中SGB组46例，对照组47例。SGB组患者在手术过程中的心率较对照组低，MAP也较对照组更稳定（F=333.662，P<0.05）。单肺通气后，两组患者肺内分流量明显增加。在T2～T5时间点，SGB组患者氧合指数高于对照组（F=793.218，P<0.05），而肺内分流率（Qs/Qt）低于对照组（F=549.716，P<0.05）。在T2～T4时间点，对照组患者SvO₂、rSO₂较术前明显下降，同时伴随Ca-vO₂、CERO₂升高，而SGB组患者SvO₂、rSO₂及Ca-vO₂、CERO₂较术前无明显变化。在T2、T3时点，SGB组患者SvO₂、rSO₂较对照组高（P<0.05），而Ca-vO₂、CERO₂较对照组低（P<0.05）。SGB组中2例患者出现单侧喉返神经阻滞症状，1例患者出现臂丛神经阻滞，均未予特殊处理，于术后24 h内好转。两组均未出现严重肺部并发症。

结论

超声引导下SGB有助于减少单肺通气期间的肺内分流，改善术中氧合和脑氧代谢，具有一定的脑保护作用。

关键词: 星状神经节阻滞, 超声引导, 单肺通气, 肺内分流, 脑氧代谢

Objective

To observe the impact of ultrasound-guided stellate ganglion block (SGB) on intrapulmonary shunt and cerebral oxygen metabolism in elderly patients undergoing single-lung ventilation.

Methods

Ninety-six elderly patients who underwent thoracic surgery under one lung ventilation at Suzhou Hospital Affiliated to Nanjing Medical University from April 2020 to October 2022 were selected. Among them, 48 patients received SGB on the ventilation side under ultrasound guidance before general anesthesia (SGB group), and the remaining 48 patients did not receive SGB (control group). At the immediate start of the procedure (T0), before single-lung ventilation (T1), 15 min (T2), 30 min (T3), 60 min (T4) after single-lung ventilation, and 15 min after resumption of two-lung ventilation (T5), the patient's physiological indices, including the mean arterial pressure (MAP) and heart rate (HR), were monitored and recorded; arterial and jugular venous blood gases were analyzed to obtain pulmonary shunt fractionn (Qs/Qt) and oxygenation index (OI); Jugular venous oxygen saturation (SvO₂) and obstructed side cerebral oxygen saturation (rSO₂) were recorded, and cerebral oxygen consumption rate (CERO₂) was calculated. Complications related to SGB and postoperative pulmonary complications within 72 hours were documented. T test or analysis of variance was used for measurement data, and Chi-square test was used for counting data.

Results

A total of 93 patients were ultimately included in the statistical analysis, including 46 in the SGB group and 47 in the control group. The SGB group exhibited lower HR and more stable MAP during surgery compared with the control group (F=333.662, P < 0.05). After single-lung ventilation, both groups showed significantly increased intrapulmonary shunt. OI in the SGB group was higher, and Qs/Qt was lower than the control group at T2-T5 (F=793.218, 549.716; P < 0.05). At time points T2 to T4, the control group showed a significant decrease in SvO₂ and rSO₂ compared with preoperative values, accompanied by an increase in Ca-vO₂ and CERO₂. In contrast, the SGB group did not exhibit statistically significant changes in SvO₂, rSO₂, Ca-vO₂, and CERO₂ compared with the preoperative values. Intergroup comparisons revealed that at time points T2 and T3, SvO₂ and rSO₂ were higher in the SGB group than those in the control group (P < 0.05), while Ca-vO₂ and CERO₂ were lower in the SGB group than those in the control group (P < 0.05). Two cases of unilateral recurrent laryngeal nerve blockade and one case of brachial plexus blockade occurred in the SGB group, resolving within 24 hours without special treatment. No severe pulmonary complications occurred in both groups.

Conclusion

Ultrasound-guided SGB helps reduce intrapulmonary shunt during single-lung ventilation, improving intraoperative oxygenation and cerebral oxygen metabolism, providing a certain level of cerebral protection.

Key words: Stellate ganglion block, Ultrasound-guided, Single-lung ventilation, Intrapulmonary shunt, Cerebral oxygen metabolism

表1 两组患者一般资料和手术相关数据比较（

±s或例）

组别	例数	年龄（岁）	性别（男/女）	身高（cm）	体质量（kg）	ASA分级（Ⅰ/Ⅱ/Ⅲ）	麻醉时间（min）	手术时间（min）	单肺通气时间（min）
对照组	47	69±11	25/22	168±10	68±11	10/31/6	123±24	113±18	103±13
SGB组	46	69±11	27/19	171±10	70±12	9/30/7	125±21	119±17	100±13
检验值		t=-0.398	χ²=0.286	t=-1.157	t=-0.861	χ²=0.135	t=-0.626	t=-1.690	t=0.782
P值		>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

表1 两组患者一般资料和手术相关数据比较（

±s或例）

组别	例数	年龄（岁）	性别（男/女）	身高（cm）	体质量（kg）	ASA分级（Ⅰ/Ⅱ/Ⅲ）	麻醉时间（min）	手术时间（min）	单肺通气时间（min）
对照组	47	69±11	25/22	168±10	68±11	10/31/6	123±24	113±18	103±13
SGB组	46	69±11	27/19	171±10	70±12	9/30/7	125±21	119±17	100±13
检验值		t=-0.398	χ²=0.286	t=-1.157	t=-0.861	χ²=0.135	t=-0.626	t=-1.690	t=0.782
P值		>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

表2 两组患者不同时间点血流动力学和血气分析指标的比较（

±s）

组别	例数	MAP（mmHg）	心率（次/min）	Qs/Qt（%）	氧合指数（mmHg）	PaO₂（mmHg）	PaCO₂（mmHg）	SpO₂（%）
对照组	47
T0		94.4±5.9	78.5±5.2	1.5±0.3	427.1±43.3	89.4±10.7	38.4±5.0	98.4±1.4
T1		84.5±6.4^a	67.6±4.9^a	1.3±0.5	562.7±45.4^a	270.8±45.6^a	36.4±5.2	97.6±1.8
T2		81.3±7.3^a	68.8±3.3^a	26.7±5.7^a	206.2±31.4^a	121.1±53.7^a	39.2±5.8	96.3±3.3
T3		82.3±6.1^a	68.5±5.2^a	29.2±3.6^a	195.1±34.4^a	104.2±43.2^a	40.8±6.6	96.4±2.4
T4		91.5±4.9	77.4±7.2	18.2±4.8^a	252.8±44.6^a	147.7±38.1^a	39.2±6.3	96.5±3.5
T5		92.7±6.1	75.6±6.9	14.3±5.1^a	311.5±38.5^a	213.3±55.6^a	37.3±6.1	97.3±2.3
SGB组	46
T0		93.2±6.4	76.0±5.2	1.6±0.4	431.6±45.9	89.9±11.2	38.4±5.4	97.7±1.3
T1		76.4±7.3^ab	65.2±7.3^a	1.4±0.5	560.1±47.2^a	270.8±51.7^a	36.8±5.6	96.6±1.3
T2		73.8±6.3^ab	53.2±5.5^ab	19.9±4.6^ab	247.4±34.2^ab	157.4±44.6^ab	37.5±6.3	96.1±1.7
T3		73.8±5.2^ab	54.4±4.9^ab	19.3±4.2^ab	290.8±35.2^ab	148.1±35.9^ab	38.2±5.8	96.7±2.4
T4		90.2±5.3	70.2±6.1	10.5±4.1^ab	367.4±43.5^ab	165.2±42.6^a	39.4±5.5	96.4±1.1
T5		92.1±5.4	73.3±5.7	9.2±4.3^ab	381.2±42.7^ab	235.4±53.5^a	39.6±6.3	98.3±1.5
F₁值		40.820	36.814	427.555	608.379	122.012	1.315	1.780
P₁值		<0.01	<0.01	<0.01	<0.01	<0.01	>0.05	>0.05
F₂值		114.117	250.246	243.965	324.705	105.570	1.573	1.486
P₂值		<0.01	<0.01	<0.01	<0.01	<0.01	>0.05	>0.05
F₃值		181.123	332.662	549.716	793.218	213.079	1.472	1.581
P₃值		<0.01	<0.01	<0.01	<0.01	<0.01	>0.05	>0.05

表2 两组患者不同时间点血流动力学和血气分析指标的比较（

±s）

组别	例数	MAP（mmHg）	心率（次/min）	Qs/Qt（%）	氧合指数（mmHg）	PaO₂（mmHg）	PaCO₂（mmHg）	SpO₂（%）
对照组	47
T0		94.4±5.9	78.5±5.2	1.5±0.3	427.1±43.3	89.4±10.7	38.4±5.0	98.4±1.4
T1		84.5±6.4^a	67.6±4.9^a	1.3±0.5	562.7±45.4^a	270.8±45.6^a	36.4±5.2	97.6±1.8
T2		81.3±7.3^a	68.8±3.3^a	26.7±5.7^a	206.2±31.4^a	121.1±53.7^a	39.2±5.8	96.3±3.3
T3		82.3±6.1^a	68.5±5.2^a	29.2±3.6^a	195.1±34.4^a	104.2±43.2^a	40.8±6.6	96.4±2.4
T4		91.5±4.9	77.4±7.2	18.2±4.8^a	252.8±44.6^a	147.7±38.1^a	39.2±6.3	96.5±3.5
T5		92.7±6.1	75.6±6.9	14.3±5.1^a	311.5±38.5^a	213.3±55.6^a	37.3±6.1	97.3±2.3
SGB组	46
T0		93.2±6.4	76.0±5.2	1.6±0.4	431.6±45.9	89.9±11.2	38.4±5.4	97.7±1.3
T1		76.4±7.3^ab	65.2±7.3^a	1.4±0.5	560.1±47.2^a	270.8±51.7^a	36.8±5.6	96.6±1.3
T2		73.8±6.3^ab	53.2±5.5^ab	19.9±4.6^ab	247.4±34.2^ab	157.4±44.6^ab	37.5±6.3	96.1±1.7
T3		73.8±5.2^ab	54.4±4.9^ab	19.3±4.2^ab	290.8±35.2^ab	148.1±35.9^ab	38.2±5.8	96.7±2.4
T4		90.2±5.3	70.2±6.1	10.5±4.1^ab	367.4±43.5^ab	165.2±42.6^a	39.4±5.5	96.4±1.1
T5		92.1±5.4	73.3±5.7	9.2±4.3^ab	381.2±42.7^ab	235.4±53.5^a	39.6±6.3	98.3±1.5
F₁值		40.820	36.814	427.555	608.379	122.012	1.315	1.780
P₁值		<0.01	<0.01	<0.01	<0.01	<0.01	>0.05	>0.05
F₂值		114.117	250.246	243.965	324.705	105.570	1.573	1.486
P₂值		<0.01	<0.01	<0.01	<0.01	<0.01	>0.05	>0.05
F₃值		181.123	332.662	549.716	793.218	213.079	1.472	1.581
P₃值		<0.01	<0.01	<0.01	<0.01	<0.01	>0.05	>0.05

表3 两组患者不同时间点脑氧代谢指标的比较（

±s）

组别	例数	SvO₂（%）	rSO₂（%）	Ca-vO₂（ml/L）	CERO₂（%）
对照组	47
T0		67.4±4.5	76.8±3.1	48.2±7.5	29.9±4.3
T1		66.7±4.3	71.2±4.3	56.9±8.4	36.6±5.4
T2		56.8±3.8^a	64.3±3.7^a	61.7±9.3^a	42.6±5.7^a
T3		58.5±4.2^a	65.8±3.5^a	63.1±8.5^a	39.5±5.8^a
T4		61.2±4.5^a	67.4±4.3^a	60.9±8.3^a	38.1±5.6^a
T5		67.4±5.4	73.7±5.4	53.3±8.2	33.7±5.2
SGB组	46
T0		67.4±4.8	75.5±3.4	49.9±7.6	28.3±4.3
T1		66.5±4.5	73.6±3.7	52.4±7.7	34.4±4.2
T2		64.3±4.3^b	71.3±4.4^b	53.5±7.8^b	35.7±4.7^b
T3		66.4±4.6^b	73.5±4.4^b	52.6±7.3^b	32.6±5.2^b
T4		67.7±4.6	72.3±5.2	56.7±7.9	34.5±4.5
T5		68.1±4.7	75.6±4.3	53.4±8.2	32.7±4.3
F₁值		53.637	65.531	22.057	32.708
P₁值		<0.01	<0.01	<0.01	<0.01
F₂值		4.083	7.357	3.700	15.046
P₂值		<0.05	<0.05	<0.05	<0.01
F₃值		44.278	56.377	21.061	27.357
P₃值		<0.01	<0.01	<0.01	<0.01

表3 两组患者不同时间点脑氧代谢指标的比较（

±s）

组别	例数	SvO₂（%）	rSO₂（%）	Ca-vO₂（ml/L）	CERO₂（%）
对照组	47
T0		67.4±4.5	76.8±3.1	48.2±7.5	29.9±4.3
T1		66.7±4.3	71.2±4.3	56.9±8.4	36.6±5.4
T2		56.8±3.8^a	64.3±3.7^a	61.7±9.3^a	42.6±5.7^a
T3		58.5±4.2^a	65.8±3.5^a	63.1±8.5^a	39.5±5.8^a
T4		61.2±4.5^a	67.4±4.3^a	60.9±8.3^a	38.1±5.6^a
T5		67.4±5.4	73.7±5.4	53.3±8.2	33.7±5.2
SGB组	46
T0		67.4±4.8	75.5±3.4	49.9±7.6	28.3±4.3
T1		66.5±4.5	73.6±3.7	52.4±7.7	34.4±4.2
T2		64.3±4.3^b	71.3±4.4^b	53.5±7.8^b	35.7±4.7^b
T3		66.4±4.6^b	73.5±4.4^b	52.6±7.3^b	32.6±5.2^b
T4		67.7±4.6	72.3±5.2	56.7±7.9	34.5±4.5
T5		68.1±4.7	75.6±4.3	53.4±8.2	32.7±4.3
F₁值		53.637	65.531	22.057	32.708
P₁值		<0.01	<0.01	<0.01	<0.01
F₂值		4.083	7.357	3.700	15.046
P₂值		<0.05	<0.05	<0.05	<0.01
F₃值		44.278	56.377	21.061	27.357
P₃值		<0.01	<0.01	<0.01	<0.01

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Effects of utrasound-guided stellate ganglion block on pulmonary shunting and cerebral oxygen metabolism in elderly patients undergoing single-lung ventilation

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Effects of utrasound-guided stellate ganglion block on pulmonary shunting and cerebral oxygen metabolism in elderly patients undergoing single-lung ventilation