摘要目的 探讨星状神经节阻滞(SGB)对甲状腺手术患者颈丛阻滞时心率变异性的影响.方法 择期行甲状腺腺瘤切除术的患者45例,ASA Ⅰ或Ⅱ级,年龄20～60岁,体重40～70 kg,性别不限,随机分为3组(n=15):对照组(C组)、左侧SCB组(LS组)及右侧SGB组(RS组).SGB成功后15 min行颈丛神经阻滞.于入室后(基础状态)、颈丛阻滞结束即刻、阻滞5min.10min、切皮及术毕时记录SBP、DBP、HR;心率变异性参数:总功率(TP)、低频功率(LF)、高频功率(HF)、低频与高频比值(IF/HF比值),并计算LF、HF的标准化值(LFnu、HFnu).结果 与基础值相比,术中C组LFnu和LF/HF比值升高,HR、HF及HFnu下降,RS组LF、HF及HFnu下降,HR升高,三组SBP和DBP均升高(P<0.05或0.01),LS组心率变异性参数差异无统计学意义(P>0.05).与C组相比,LS组HR、LFnu下降,HF和HFnu升高(P<0.05),RS组上述指标差异无统计学意义(P>0.05).结论 甲状腺手术患者颈丛阻滞前行SGB可调节颈丛阻滞引起的交感神经兴奋性,维持交感/副交感神经张力平衡,且左侧SGB效果较好.

abstractsObjective To investigate the effect of stellate ganglion block(SGB)on heart mte variability (HRV)during thyroidectomy performed under cervical plexus block.Methods Forty-five ASA Ⅰ or Ⅱ pafients of both sexy8(8 males,37 females) aged 20-60 yr,weighing 40-70 kg undergoing elective thyroidectomy under cervical plexus block were randomly divided into 3 groups(n=15 each):group Ⅰ control,group Ⅱ left SGB and group Ⅲ right SGB.The parameters of HRV included low frequency(LF),high frequency(HF),LFnu,HFnu and LF/HF ratio.SBP,DBP,HB and HRV parameters were recorded before anesthesia(To,baseline),immediately(T1) and at 5 and 10 rain after cervical plexus block(T2,T3),at the beginning and end of operation (T4,T5).Results SBP and DBP were significantly increased at different time points after cervical plexus block in all 3 groups.Compared with the baseline at T0,LFnu and LF/HF ratio were significantly increased while HR,HF and HFnu decreased during operation in group Ⅰ,LF,HF and HFnu were significantly decreased while HR increased during operation in group Ⅲ(P<0.05),but no significant change in HRV parameters was found during operation in group Ⅱ(P>0.05).Compared with group Ⅰ,HR and LFnu were significantly decreased while HF and HFnu increased in group Ⅱ(P<0.05),but no significant change was found in the indexes mentioned abovein group Ⅲ (P>0.05).Conclusion SGB can adjust cervical plexus block-induced sympathetic excitability and maintain the balance between sympathetic and parasympathetic tension.Left SGB outweighs right SGB.