张旭标 聂颖

[摘要]目的 探討星状神经节阻滞（SGB）对动脉瘤性蛛网膜下腔出血（aSAH）患者的影响。方法 选取2017年9月～2019年8月我院收治的78例行全身麻醉下介入治疗的aSAH患者作为研究对象，按照随机数字表法分为观察组（39例）与对照组（39例）。对照组采用常规气管内插管，静息复合维持麻醉下介入治疗，观察组采用罗哌卡因行SGB。比较两组的脑血流动力学指标[大脑中动脉（MCA）、大脑前动脉（ACA）、大脑后动脉（PCA）的平均血流速度（Vm）]、内皮素-1（ET-1）、S100B蛋白、神经特异性烯醇酶（NSE）及脑血管痉挛（CVS）发生率。结果 治疗前两组MCA、ACA、PCA的Vm及ET-1、S100B、NSE比较，差异无统计学意义（P>0.05）;治疗后观察组MCA、ACA、PCA的Vm及ET-1、S100B、NSE均低于对照组，差异有统计学意义（P<0.05）;观察组的CVS发生率低于对照组，差异有统计学意义（P<0.05）。结论 SGB能够改善aSAH患者脑血流动力学，减轻脑神经损伤，降低CVS发生率。

[关键词]动脉瘤性蛛网膜下腔出血;星状神经节阻滞;脑血流动力学;脑血管痉挛

[中图分类号] R743.35          [文献标识码] A          [文章编号] 1674-4721（2020）7（a）-0061-03

Influence of stellate ganglion block on the patients with aneurysmal subarachnoid hemorrhage

ZHANG Xu-biao1   NIE Ying2

1. Department of Neurosurgery， Guangdong 999 Brain Hospital， Guangdong Province， Guangzhou   510515， China; 2. Department of Anesthesiology， Guangdong 999 Brain Hospital， Guangdong Province， Guangzhou   510515， China

[Abstract] Objective To investigate the influence of stellate ganglion block （SGB） on the patients with aneurysmal subarachnoid hemorrhage （aSAH）. Methods A total of 78 patients with aSAH who were given invasive treatment under general anesthesia in our hospital from September 2017 to August 2019 were selected as the research subjects. They were divided into the observation group （39 cases） and the control group （39 cases） according to the random number table method. The control group was given conventional endotracheal intubation and resting combined with invasive therapy under maintenance anesthesia. The observation group was given Ropivacaine for SGB. The cerebral hemodynamic indicators （mean blood flow velocity [Vm] of middle cerebral artery [MCA]， anterior cerebral artery [ACA]， and posterior cerebral artery [PCA]）， endothelin-1 （ET-1）， S100B protein， neurospecific enolase （NSE） and the incidence of cerebral vasospasm （CVS） were compared between the two groups. Results There were no significant differences in VM of MCA， ACA PCA， and ET-1， S100B， NSE between the two groups before treatment （P>0.05）. After treatment， the Vm of MCA， ACA， PCA and ET-1， S100B， NSE in the observation group were lower than those in the control group， and the differences were statistically significant （P<0.05）. The incidence rate of CVS in the observation group was lower than that in the control group， and the difference was statistically significant （P<0.05）. Conclusion SGB can improve cerebral hemodynamics， reduce cerebral nerve damage， and reduce the incidence rate of CVS in the patients with aSAH.

[Key words] Aneurysmal subarachnoid hemorrhage; Stellate ganglion block; Cerebral hemodynamics; Cerebral vasospasm

颅内动脉瘤是导致蛛网膜下腔出血（SAH）的主要原因，动脉瘤性蛛网膜下腔出血（aSAH）患者可出现脑膜刺激征反应，甚至出现偏瘫、昏迷等症状，危及患者生命安全[1-2]。目前，颅内动脉瘤发病机制仍未完全明晰，但临床上普遍认为其发生与颅内动脉管壁局部先天性缺陷、腔内压力增高等有关，且脑动脉硬化、血管炎及高血压与其发生具有密切联系。介入栓塞作为微创治疗方法，虽能够封堵动脉瘤，防止动脉瘤破裂，但介入术后脑出血及脑血管痉挛（CVS）等发生率较高，易诱发迟发性脑缺血及脑水肿，是导致患者术后死亡的重要原因[3-4]。星状神经节阻滞（SGB）通过向颈部星状神经节及其周围结缔组织注射局部麻醉药，具有神经内分泌系统调节作用，有助于降低血管神经递质释放，扩张脑血管，改善脑血流[5]。鉴于……