星状神经节阻滞对非体外循环冠状动脉搭桥术患者心肌损伤的影响

摘要

Objective To explore the application values and the effect of myocardial preservation of right stellate ganglion block in off-pump coronary artery bypass grafting (OPCABG). Methods Sixty-two patients with ASA Ⅱ or Ⅲ,aged 50-75 years,scheduled for OPCABG were randomly divided into stellate ganglion block group (group SGB)and control group (group C)with 31 cases each.The patients in group SGB received right-lateral SGB before anesthesia induction.The medications and methods of anesthesia induction in the two groups were identical.Hemodynamics be-fore start of anethesia (T0 ),after induction (T1 ),after intubation tube (T2 ),after sternotomy (T3 ),at the beginning of bypass surgery for interrupted coronary artery (T4 ),at the end of coronary bypass grafting (T5 )were observed.Meanwhile,changes of serum cardiac troponin I (cTnI)and cre-atine phosphokinase MB (CK-MB)at T0 ,6 h (T6 ),12 h (T7 ),24 h (T8 )after operation were also observed.The operative time,the amount of drugs used and postoperative recovery were recored. Results MAP,HR of group SGB increased at T2-T5 compared with T0 ,and MAP,HR of group C significantly increased at T2-T5 comparing with T0 (P <0.05).Compared with those in group SGB, MAP,HR significantly increased at T2-T5 in group C (P <0.05 ).The Concentrations of cTnI and CK-MB of group C increased more obviously than those in group SGB at T6-T8 (P <0.05).Compared with group C,patients in group SGB needed less medication,less hospitalization time in ICU and had faster postoperative recovery.Conclusion SGB for patients during OPCABG stabilizes hemodynamy stability,further reduces myocardial injury,thus protecting myocardium.%目的：探讨星状神经节阻滞(stellate ganglion block,SGB)在非体外循环冠状动脉搭桥术(off-pump coronary artery bypass grafting,OPCABG)中的应用价值及对心肌损伤的影响。方法选择择期行 OPCABG 患者62例,男46例,女16例,年龄50~75岁,ASA Ⅱ或Ⅲ级,随机分为星状神经节阻滞组(SGB 组)和对照组(C 组),每组31例。SGB 组患者诱导前用1%利多卡因和0.25%罗哌卡因混合液8~10 ml 行右侧星状神经节阻滞,两组麻醉诱导和维持方法相同。记录患者麻醉前(T0)、麻醉诱导后(T1)、气管插管后1 min(T2)、劈胸骨后(T3)、开始搭桥时(T4)、搭桥结束时(T5)的 MAP 和 HR,记录 T0时及术后6 h(T6)、12 h(T7)、24 h(T8)血清心肌肌钙蛋白 I(cTnI)、磷酸肌酸同工酶(CK-MB)浓度,记录术后24 h 血管活性药物用量及术后恢复情况。结果与 T0时比较,T1时两组患者 MAP 明显降低、HR 明显增快(P <0.05),T2~T5时 C 组 MAP 明显升高、HR明显增快(P <0.05)；T2~T5时 SGB 组 MAP 明显低于 C 组,HR 明显慢于 C 组(P <0.05)。与 T0时比较,T6~T8时两组血清 cTnI 和 CK-MB 浓度明显升高(P <0.05)；T6~T8时 SGB 组血清 cTnI和 CK-MB 浓度明显低于 C 组(P <0.05)。SGB 组术后拔管时间及 ICU 滞留时间短于 C 组、术后24 h 多巴胺和硝酸甘油用量少于 C 组,但差异无统计学意义。结论星状神经节阻滞用于非体外循环冠状动脉搭桥术,可稳定血流动力学,减轻心肌的进一步损伤,产生一定的心肌保护作用。