单次星状神经节阻滞预防胸腔镜肿瘤术后心律失常
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A single-dose of stellate ganglion block for the prevention of postoperative dysrhythmias in patients undergoing thoracoscopic surgery for cancer: A randomised controlled double-blind trial
背景与目的
开胸手术患者术后常常发生新发心律失常和睡眠障碍。本研究旨在评价单次星状神经节阻滞(SGB)预防胸部肿瘤手术患者心律失常发生的有效性。
选取90例拟择期行视频胸腔镜辅助下肺癌或食道癌手术的患者随机分为两组(SGB组和对照组，各40例)。SGB组患者在全身麻醉诱导前，在超声引导下行SGB，单次注射0.5%罗哌卡因5ml。术后48小时内连续监测动态心电图，术后前两晚监测睡眠状态。
结 果
术后48小时内，SGB组术后室上性心动过速的发生率低于对照组；分别为11.6%(5/43)和31.8%(14/44)，P=0.023(优势比0.28，95%可信区间0.09~0.87)。在术后前两晚，SGB还延长了总睡眠时间，提高了睡眠效率。术后第1天晚上N2期睡眠时间SGB组[94（四分位间距，69～113）min]较对照组[28（四分位间距，14～58）min，P＜0.016]延长。两组术后第一晚N1、N3期睡眠时长(分别为0.180、0.086)和第二晚N1、N2、N3期睡眠时长(分别为0.194、0.057、0.405)差异无统计学意义(P>0.05)。
结 论
术前给予SGB能有效地预防术后室上性心动过速的发生，改善胸部肿瘤手术患者的睡眠质量。
原始文献摘要
Wu CN, Wu XH, Yu DN, et,al.A single-dose of stellate ganglion block for the prevention of postoperative dysrhythmias in patients undergoing thoracoscopic surgery for cancer: A randomised controlled double-blind trial[J].Eur J Anaesthesiol 2020 Apr;37(4). DOI:10.1097 /EJA. 0000000000001137.
BACKGROUND New-onset arrhythmias and sleep distur-bances are frequently observed during the postoperative period in patients undergoing thoracic surgery.
OBJECTIVE We evaluated the effectiveness of a single-dose stellate ganglion block (SGB) to prevent the occurrence of arrhythmias in patients undergoing thoracic surgery for cancer.
DESIGN Randomised controlled double-blind study.
SETTING Single university hospital.
PATIENTS Ninety patients with lung cancer or oesophagal cancer scheduled for elective video-assisted thoracoscopic surgery were randomly randomised into one of two equal groups (the SGB group and control group, n¼40 each).
INTERVENTIONS Patients received a single dose of 5 ml of 0.5% ropivacaine during ultrasound-guided SGB before induction of general anaesthesia in the SGB group.
MAIN OUTCOME MEASURES Holter ECG was continuously monitored during the first 48 postoperative hours, and sleep state was monitored during the first two postoperative nights.
RESULTS The incidences of postoperative supraventricular tachycardias were lower in the SGB group compared with the control group during the first48postoperativehours;11.6(5/43) vs. 31.8% (14/44), respectively, P¼0.023 (odds ratio 0.28, 95% confidence interval 0.09 to 0.87). The SGB also prolonged the total sleep time and increased the sleep efficiency during the first two postoperative nights. The duration of stage N2 sleep was longer in the SGB group compared with the control group [28 (interquartile range, 14 to 58) to 94(interquartile range, 69 to 113)min, P¼0.016] on the first postoperativenight. There were no differences in theduration of stage N1 and N3 sleep (P¼0.180, 0.086, respectively) on the first postoperative night, and the duration of stage N1, N2 and N3 sleep (P¼0.194, 0.057, 0.405, respectively) on the second postoperative night between the groups.
CONCLUSION A pre-operative SGB effectively prevented the occurrence of postoperative supraventricular tachycardias and improves the objective sleep quality in patients undergoing thoracic surgery for cancer.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：任文鑫 编辑：冯玉蓉 审校：王贵龙