南方医科大学学报

南方医科大学学报 ›› 2022, Vol. 42 ›› Issue (12): 1807-1814.doi: 10.12122/j.issn.1673-4254.2022.12.08

• • 上一篇    下一篇

超声引导下的星状神经节阻滞可改善老年肺癌患者胸腔镜术后早期睡眠：86例前瞻性随机对照试验

古翠方，翟明见，吕爱俊，刘 露，胡 欢，刘 溪，李 璇，程向阳   

  1. 蚌埠医学院第一附属医院麻醉科，安徽 蚌埠 233000
  • 出版日期:2022-12-20 发布日期:2023-01-12

Ultrasound-guided stellate ganglion block improves sleep quality in elderly patients early after thoracoscopic surgery for lung cancer: a randomized controlled study

GU Cuifang, ZHAI Mingjian, LÜ Aijun, LIU Lu, HU Huan, LIU Xi, LI Xuan, CHENG Xiangyang   

  1. Department of Anesthesiology, First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, China
  • Online:2022-12-20 Published:2023-01-12

RichHTML

23

PDF

1214

摘要： 目的 探讨超声引导下星状神经节阻滞(SGB)对老年肺癌患者胸腔镜手术后早期睡眠的影响。方法 纳入我院择期行胸腔镜手术的肺癌患者86例，年龄60~80岁，BMI 20~27 kg/m2，ASA I-III级，随机分为星状神经节阻滞组（SGB组，n=43）和对照组（对照组，n=43）。麻醉诱导前30 min，SGB组在超声引导下行C6-7水平右侧星状神经节阻滞，给予0.5%罗哌卡因7 mL；对照组在相同位置给予生理盐水7 mL。我们需要通过BIS-Vista监测术前最后1晚、术后第1晚及术后第2晚的睡眠持续时间、睡眠效率指数和N3睡眠阶段；记录术前、术后第1天及术后第2天的主观睡眠阿森斯失眠（AIS）评分；采取患者静脉血样，测定星状神经节阻滞前（T1）、拔管后5 min（T2）及术后第1天早上6:00（T4）血浆去甲肾上腺素、皮质醇的浓度；采取患者晨尿样本，测定手术当天早上6:00（T3）、术后第1天早上6:00（T4）、术后第2天早上6:00（T5）晨尿中6-羟基硫酸褪黑素（6-HMS）的浓度；我们还需要记录VAS评分、术后谵妄发生率、术后抑郁发生率、术后舒芬太尼用量、术后住院时间。结果 最后SGB组有36例患者，对照组有35例患者纳入分析。两组患者术后大多出现失眠，但与对照组相比，SGB组患者术后第1晚及术后第2晚的睡眠持续时间更长（P<0.05），睡眠效率指数更高（P<0.05），N3阶段睡眠时间更长（P<0.05）；与对照组相比，SGB组患者术后AIS评分更低，术后失眠率更低（P<0.05）；与对照组相比，SGB组患者在T2、T4时间点血浆中去甲肾上腺素及皮质醇浓度更低（P<0.05），T5时间点晨尿中6-HMS浓度更高（P<0.05），术后住院时间更短（P<0.05），术后拔管时间、VAS评分、术后舒芬太尼用量、术后谵妄、术后抑郁发生率无明显差异。结论 超声引导下SGB可以改善老年肺癌患者胸腔镜手术后早期客观及主观睡眠，使应激反应与睡眠障碍间的恶性循环关系有所缓解，减少术后住院天数，促进患者快速康复。

关键词: 肺癌；睡眠障碍；星状神经节阻滞；应激反应

Abstract: Objective To investigate the effects of ultrasound-guided stellate ganglion block (SGB) on sleep quality in elderly patients with lung cancer early after thoracoscopic surgery. Methods A total of 86 patients with lung cancer (ASA class I-III, aged 60-80 years) undergoing elective thoracoscopic surgery were randomized into stellate ganglion block (SGB) group (n=43) and control group (n=43) to receive ultrasound-guided right SGB with 7 mL of 0.5% ropivacaine at the C6-7 level and injection of 7 mL saline at the same site 30 min before anesthesia induction, respectively. On the day before surgery and the first two days after the surgery, sleep duration, sleep efficiency index (SEI) and N3 sleep stage of the patients were monitored using a BIS-Vista monitor, and Athens Insomnia Scale (AIS) scores were recorded. The plasma levels of norepinephrine and cortisol of the patients were measured before SGB (T1), at 5 min after extubation (T2) and at 6:00 on the first morning after the surgery (T4). Urine levels of 6-hydroxysulfate melatonin (6-HMS) were measured at 6:00 in the morning for 3 consecutive days starting on the day of surgery (T3, T4 and T5, respectively). VAS score, incidences of postoperative delirium and depression, sufentanil consumption after surgery, and discharge time of the patients were recorded. Results Thirty-six patients in SGB group and 35 in the control group were analyzed. In both groups, most of the patients had insomnia after surgery, but compared with those in the control group, the patients in SGB group had significantly longer sleep duration (P<0.05) with a higher sleep efficiency index (P<0.05) and a longer sleep time in N3 stage (P<0.05) on the first two nights after surgery. The mean postoperative AIS score and incidence of insomnia were significantly lower in SGB group than in the control group (P<0.05). Compared with the control group, SGB group showed significantly lower plasma levels of norepinephrine and cortisol at T2 and T4 (P<0.05), a higher urine level of 6-HMS at T5 (P<0.05), and a shorter discharge time after the surgery (P<0.05). The VAS scores, postoperative incidences of delirium and depression, or postoperative sufentanil consumption did not differ significantly between the two groups. Conclusion Ultrasound-guided SGB improves objective and subjective sleep quality in elderly patients early after thoracoscopic surgery for lung cancer to alleviate stress responses and sleep disorders, reduce postoperative hospital stay, and accelerate postoperative recovery of the patients.

Key words: lung cancer; sleep disorders; stellate ganglion block; stress responses