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中华消化病与影像杂志(电子版) ›› 2025, Vol. 15 ›› Issue (04) : 405 -411. doi: 10.3877/cma.j.issn.2095-2015.2025.04.020

论著

星状神经节阻滞联合右美托咪定在胃肠手术中的麻醉效果及其与胃肠功能相关性研究
唐建新1, 邓晋1, 谢威1, 唐夏玉2, 王斯旗1,†()   
  1. 1425006　湖南省，永州市中心医院（南华大学附属永州医院）麻醉科
    2425006　湖南省，永州市中心医院（南华大学附属永州医院）胃肠外科
  • 收稿日期:2025-03-01 出版日期:2025-08-01
  • 通信作者: 王斯旗

Study on the anesthetic effect of stellate ganglion block combined with dexmedetomidine in gastrointestinal surgery and its correlation with gastrointestinal function

Jianxin Tang1, Jin Deng1, Wei Xie1, Xiayu Tang2, Siqi Wang1,†()   

  1. 1Department of Anesthesiology, Central Hospital of Yongzhou (Yongzhou Hospital Affiliated to University of South China), Yongzhou 425006, China
    2Department of Gastrointestinal Surgery, Central Hospital of Yongzhou (Yongzhou Hospital Affiliated to University of South China), Yongzhou 425006, China
  • Received:2025-03-01 Published:2025-08-01
  • Corresponding author: Siqi Wang
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引用本文：

唐建新, 邓晋, 谢威, 唐夏玉, 王斯旗. 星状神经节阻滞联合右美托咪定在胃肠手术中的麻醉效果及其与胃肠功能相关性研究[J/OL]. 中华消化病与影像杂志(电子版), 2025, 15(04): 405-411.

Jianxin Tang, Jin Deng, Wei Xie, Xiayu Tang, Siqi Wang. Study on the anesthetic effect of stellate ganglion block combined with dexmedetomidine in gastrointestinal surgery and its correlation with gastrointestinal function[J/OL]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2025, 15(04): 405-411.

目的

探究星状神经节阻滞（SGB）联合右美托咪定在胃肠肿瘤手术中的麻醉效果与胃肠功能相关性。

方法

选取2019年1月至2023年1月在永州市中心医院（南华大学附属永州医院）进行胃肠手术的患者作为本次研究对象，共135例。根据患者术中麻醉方式不同分为对照组（n=64）和研究组（n=71），对照组给予盐酸右美托咪定注射液，研究组采用SGB联合右美托咪定，在此基础上所有患者术中均采用常规麻醉诱导。比较两组患者手术前、麻醉后、术毕时的血流动力学指标[心率（HR）、收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）]和氧化应激指标[丙二醛（MDA）、超氧化物歧化酶（SOD）、皮质醇]；比较术后12 h、24 h、48 h的疼痛评分（VAS），以及全麻患者麻醉苏醒状况（拔管时间、睁眼时间和清醒时间）和胃肠道功能恢复（排气时间、排便时间、流质食物进食时间）。并记录患者术后胃肠道症状评定量表（I-FEED）评分及术后24 h炎性因子水平，利用spearman分析评估患者应激指标和术后胃肠道功能的关系。

结果

研究组患者术中和术毕的HR、SBP、DBP、MAP指标及MDA、SOD、皮质醇、IL-6、TNF-α及IL-1β水平、LF/HF值均低于对照组，RMSSD值高于对照组（P<0.05），且研究组患者各时间点的VAS评分显著降低，拔管时间、睁眼时间、清醒时间、排气时间、排便时间和流质食物进食时间缩短（P<0.05）。所有患者术后I-FEED评分与术毕的应激指标水平呈正相关性（P<0.05）。

结论

对于行胃肠手术的患者，麻醉后应激障碍情况会影响术后胃肠功能的恢复，而SGB联合右美托咪定麻醉能有效缓解患者术后氧化应激及疼痛情况，有利于促进患者胃肠道功能恢复。

关键词: 星状神经节阻滞, 右美托咪定, 氧化应激指标, 胃肠道功能
Objective

To analyze the anesthetic effect and the correlation with gastrointestinal function of stellate ganglion block (SGB) combined with dexmedetomidine in gastrointestinal tumor surgery.

Methods

A total of 135 patients who underwent gastrointestinal surgery at Yongzhou Central Hospital (Yongzhou Hospital Affiliated to University of South China) from January 2019 to January 2023 were selected as the research subjects of this study. According to the different intraoperative anesthesia methods of the patients, they were divided into the control group (n=64) and the study group (n=71). The control group was given dexmedetomidine hydrochloride injection, while the study group was treated with SGB combined with dexmedetomidine. On this basis, all patients were induced with conventional anesthesia during the operation. The hemodynamic indicators [heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP)] and oxidative stress indicators [malondialdehyde (MDA), superoxide dismutase (SOD), cortisol] of the two groups of patients before surgery, after anesthesia and at the end of surgery were compared. The pain scores (VAS) at 12 hours, 24 hours and 48 hours after the operation were compared, as well as the anesthesia recovery status (extubation time, eye-opening time and awakening time) and the recovery of gastrointestinal function (exhaust time, defecation time and liquid food consumption time) of patients under general anesthesia. The scores of the postoperative Gastrointestinal Symptom Rating Scale (I-FEED) of the patients and the levels of inflammatory factors 24 hours after the operation were recorded. Spearman analysis was used to evaluate the relationship between the stress indicators of the patients and the postoperative gastrointestinal function.

Results

The indicators of HR, SBP, DBP, MAP, the levels of MDA, SOD, cortisol, IL-6, TNF-α and IL-1β, and the LF/HF value of the patients in the study group during and after the operation were all lower than those in the control group, and the RMSSD value was higher than that in the control group (P<0.05), and the VAS scores at each time point in the study group were significantly lower than those in the control group. The extubation time, eye-opening time, awake time, exhaust time, defecation time and liquid food intake time were shortened (P<0.05). The postoperative I-FEED score of all patients was positively correlated with the stress index level at the end of operation (P<0.05).

Conclusion

For patients undergoing gastrointestinal surgery, postanesthesia stress disorder will affect the recovery of gastrointestinal function after surgery, and SGB combined with dexmedetomidine anesthesia can effectively relieve oxidative stress and pain after surgery, which is conducive to promoting the patients’ gastrointestinal function recovery.

Key words: Stellate ganglion block, Dexmedetomidine, Oxidative stress indicators, Gastrointestinal function
表1 两组患者一般资料比较
组别 例数 性别(例) 年龄(岁, ± s) 体重指数(kg/m2, ±s) 手术类型(例) ASA分级(例) 高血压(例) 糖尿病(例) TNM分期(例) 肿瘤部位(例)
男 女 胃癌切除 肠道肿瘤切除 Ⅰ级 Ⅱ级 Ⅲ级 Ⅰ期 Ⅱ期 Ⅲ期 胃窦 胃体/贲门 结肠
研究组 71 37 34 67.52±7.19 22.23±2.41 29 42 25 38 8 12 8 15 32 24 18 11 42
对照组 64 34 30 67.41±7.12 22.49±2.76 26 38 22 34 8 10 7 12 30 22 15 11 38
t/χ2值   0.014 0.093 0.585 0.001 0.409 0.537 0.004 0.596 2.148
P值   0.906 0.926 0.560 0.979 0.815 0.464 0.951 0.742 0.143
表2 两组患者术中麻醉深度比较（ ± s）
组别 例数 脑电双频指数
术前 手术开始 术毕
研究组 71 46.06±4.25 46.64±5.04 46.45±4.40
对照组 64 45.90±4.60 46.61±4.56 46.34±4.53
F组间/ P组间   0.047/ >0.05
F时间/ P时间   0.717/ >0.05
F交互/ P交互   0.006/ >0.05
表3 两组患者术中血流动力学指标比较（ ± s）
组别 例数 心率(次/min) 收缩压(mmHg)
术前 手术开始 术毕 术前 手术开始 术毕
研究组 71 73.41±7.66 75.00±7.80 75.21±7.93 124.73±10.83 125.03±10.10 126.44±11.14
对照组 64 74.14±7.54 81.61±6.36ab 79.09±7.77ab 125.13±10.90 130.45±12.03ab 132.89±12.80ab
F组间/ P组间   24.82/ <0.001 13.23/ <0.001
F时间/ P时间   13.11/ <0.001 5.98/ 0.003
F交互/ P交互   5.12/ 0.006 2.76/ 0.06
组别 例数 舒张压(mmHg) 平均动脉压(mmHg)
术前 手术开始 术毕 术前 手术开始 术毕
研究组 71 79.49±7.29 82.35±8.43 80.65±8.21 96.59±6.87 95.10±6.61 94.37±7.33
对照组 64 79.00±7.17 91.27±9.17ab 88.70±8.55 ab 96.13±6.51 99.84±6.85 ab 103.20±6.41ab
F组间/ P组间   45.79/ <0.001 41.96/ <0.001
F时间/ P时间   30.77/ <0.001 4.32/ 0.014
F交互/ P交互   13.68/ <0.001 15.88/ <0.001
表4 两组患者手术前后氧化应激指标比较（ ± s）
组别 例数 丙二醛(μmol/L) 超氧化物歧化酶(U/mL) 皮质醇(U/L)
术前 术毕 术前 术毕 术前 术毕
研究组 71 2.44±0.41 5.31±0.87 82.32±9.26 90.15±9.88 116.56±11.48 133.35±15.75
对照组 64 2.51±0.48 6.85±1.58 82.15±9.10 106.93±11.64 117.82±12.36 155.48±13.47
t值   0.914 7.106 0.107 9.056 0.614 8.726
P值   0.363 <0.001 0.915 <0.001 0.540 <0.001
表5 两组患者术中迷走神经活性比较（ ± s）
组别 例数 相邻正常R-R间期差值的均方根(ms) 低频功率/高频功率
术前 手术开始 术毕 术前 手术开始 术毕
研究组 71 28.77±4.98 26.76±4.96 27.78±5.02 1.20±0.35 1.12±0.29 1.16±0.28
对照组 64 27.75±5.86 18.97±4.48ab 21.30±5.11ab 1.23±0.35 2.12±0.57ab 2.15±0.52ab
F组间/ P组间   102.418/ <0.001 247.207/ <0.001
F时间/ P时间   39.429/ <0.001 48.569/ <0.001
F交互/ P交互   16.679/ <0.001 63.923/ <0.001
表6 两组患者术后疼痛视觉模拟评分比较[M（Q1，Q3）]
组别 例数 术后12 h 术后24 h 术后48 h
研究组 71 5(2,8) 4(2,5)a 3(2,4)a
对照组 64 6(2,9)b 4(2,6)ab 3(2,5)ab
Wald χ2 组间/ P组间   22.89/ <0.001
Wald χ2 时间/ P时间   975.44/ <0.001
Wald χ2交互/ P交互   33.20/ <0.001
表7 两组患者苏醒状况比较（min， ± s）
组别 例数 拔管时间 睁眼时间 清醒时间
研究组 71 17.15±2.39 22.25±3.69 26.93±4.01
对照组 64 20.06±3.15 27.13±4.02 31.22±4.31
t值   6.076 7.346 5.987
P值   <0.001 <0.001 <0.001
表8 两组患者术后胃肠道功能恢复时间比较（ ± s）
组别 例数 排气时间(h) 排便时间(h) 流质食物进食时间(d) I-FEED评分[M(Q1,Q3)]
研究组 71 25.90±3.06 70.12±4.06 3.37±0.94 6(1,11)
对照组 64 27.98±4.25 78.64±4.42 4.02±1.06 9(4,15)
t值   3.289 11.670 3.761 8.235
P值   0.001 <0.001 <0.001 <0.001
表9 两组患者手术前后炎性因子水平比较（ ± s）
组别 例数 白细胞介素6(pg/mL) 肿瘤坏死因子α(pg/mL) 白细胞介素1β(pg/mL)
术前 术后 术前 术后 术前 术后
研究组 71 12.23±3.56 13.53±3.25 30.01±5.42 30.26±5.18 37.15±6.47 37.49±6.28
对照组 64 12.29±3.20 17.69±4.03 29.97±4.69 36.28±6.05 36.95±6.01 41.08±5.94
t值   -0.094 6.646 0.040 6.226 0.182 3.402
P值   0.925 <0.001 0.968 <0.001 0.856 <0.001
图1 氧化应激指标和I-FEED评分的相关性分析
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