星状神经节阻滞对腹腔镜全子宫切除术患者术后睡眠质量和恶心呕吐的影响

Effect of stellate ganglion block on postoperative sleep quality and nausea and vomiting in patients undergoing laparoscopic total hysterectomy

中文关键词: 星状神经节阻滞  腹腔镜全子宫切除术  术后睡眠障碍  术后恶心呕吐  术后疼痛

英文关键词: Stellate ganglion block  Laparoscopic total hysterectomy  Postoperative sleep disorder  Postoperative nausea and vomiting  Postoperative pain

中文摘要:

      
目的 观察超声引导下右侧星状神经节阻滞（SGB）对腹腔镜全子宫切除术患者术后睡眠质量和恶心呕吐（PONV）的影响。
方法 选择择期行腹腔镜全子宫切除术患者98例，年龄42～74岁，BMI 19～25 kg/m ²，ASAⅠ或Ⅱ级。采用随机数字表法分为两组：全身麻醉联合SGB组（S组）和全身麻醉组（GA组），每组49例。S组于麻醉诱导前在超声引导下行右侧SGB，注入 0.2%罗哌卡因5 ml，GA组不行SGB。两组采用相同的全身麻醉方法和麻醉药物。记录术前1 d、手术当日、术后1 d的匹兹堡睡眠质量指数（PSQI）。记录术后24 h PONV分级和止吐药补救情况。记录术后24 h活动时VAS疼痛评分、镇痛药补救情况、术后首次下床活动时间和术后住院时间。记录局麻药中毒、全脊髓麻醉、气胸、臂丛神经阻滞等SGB相关并发症发生情况。
结果 与GA组比较，S组手术当日、术后1 d PSQI评分、POSD发生率明显降低（P＜0.05），PONV 0级、1级发生率明显升高，PONV 2级、3级、4级发生率、止吐药补救率明显降低（P＜0.05），术后24 h活动时VAS疼痛评分明显降低（P＜0.05），术后首次下床活动时间明显缩短（P＜0.05）。两组补救镇痛情况、术后住院时间差异无统计学意义。S组无一例出现局麻药中毒、全脊髓麻醉、气胸、臂丛神经阻滞等SGB相关并发症。
结论 右侧星状神经节阻滞可有效改善腹腔镜全子宫切除术患者的术后睡眠质量，降低术后恶心呕吐的发生率及严重程度，减轻术后疼痛。

英文摘要:

      
Ojective To observe the effects of ultrasound-guided right stellate ganglion block (SGB) on postoperative sleep quality and nausea and vomiting (PONV) in patients undergoing laparoscopic total hysterectomy.
Methods Ninety-eight female patients, aged 42-74 years, BMI 19-25 kg/m ², ASA physical status Ⅰ or Ⅱ, were selected for elective laparoscopic total hysterectomy. The random number table method was used to divide into two groups: general anesthesia combined with SGB group (group S) and general anesthesia group (group GA), 49 patients in each group. The patients in group S, right SGB was performed under ultrasound guidance before induction of anesthesia, and 0.2% ropivacaine 5 ml was injected, and the patients in group GA, SGB was not performed. The same general anesthetic method and anesthetic drugs were used in both groups. The scores of the Pittsburgh sleep quality index scale (PSQI) were recorded at 1 day before surgery, on the day of surgery, and 1 day after surgery. The 24 hours postoperative degree of PONV, and antiemetic remedy were recorded. The 24 hours postoperative active VAS pain score, analgesic remedy, the time firstly getting out of bed and postoperative hospital stay were recorded. The occurrence of SGB-related complications such as local anesthetic intoxication, total spinal anesthesia, pneumothorax, and brachial plexus nerve block were recorded.
Results Compared with group GA, the incidence of PSQI score and POSD were significantly lower on the day of surgery and 1 day after surgery in group S (P < 0.05), the incidence of PONV grades 0 and 1 was significantly higher, and the incidence of PONV grades 2, 3, and 4 and the rate of antiemetic remedy were significantly lower in group S (P < 0.05), and the 24 hours postoperative activity VAS pain score was significantly lower in group S (P < 0.05). The time firstly getting out of bed was significantly shortened (P < 0.05). The differences in remedial analgesia and postoperative hospitalization time between the two groups were not statistically significant. None of the patients in group S had any SGB-related complications such as local anesthetic toxicity, total spinal anesthesia, pneumothorax, or brachial plexus nerve block.
Conclusion Right stellate ganglion block can effectively improve postoperative sleep quality, reduce the incidence and severity of postoperative nausea and vomiting, alleviate postoperative pain in patients undergoing laparoscopic total hysterectomy.