The Effect Of Stellate Ganglion Block On Inflammatory Reaction In Patients Undergoing Cardiopulmonary Bypass

Background and Objeetives:Since Kirklin found that systemic inflammatory response syndrome(SIRS) could be induced by cardiopulmonary bypass(CPB), these adverse inflammatory responses started by CPB remains an important concern. The pathophysiology of SIRS is not completely known,it results in non-physiological perfusion of CPB,mechanical stimuli of surgical trauma,organ ischemia-reperfusion and change of body temperature,ect. This inflammatory response may contribute to the development of postoperative complications,including respiratory failure,renal dysfunction,bleeding disorders,multiple organ failure,and even death. How to effectively prevent and control SIRS after CPB is constantly an investigative hotspot.As a minimally invasive therapeutic method,stellate ganglion block (SGB) has been used in the field of pain control. Lidocaine is mostly used in SGB,and SGB with ropivacaine is few. At present,SGB is developing in the treatment of non-pain,including stabilizing autonomic nervous system and cardiovascular system,adjusting immune system and endocrine system. So we investigate the influence of SGB on inflammatory responses under CPB,and explore the effect of SGB on preventing and controlling SIRS after CPB.Methods:30 patients with mitral valve replacement undergoing CPB were randomly allocated to three groups, control group(10 patients),SGB with lidocaine(LID) group(10 patients)and SGB with ropivacaine(ROP) group(10 patients). The samples were taken at twenty minutes before the anesthesia(T1),twenty minutes after the anesthesia(T2),twenty minutes after the surgery(T3), twenty minutes during CPB(T4) and twenty minutes after CPB(T5). BG was detected by photoelectric electrode method. Cor,IL-1β,IL-6 and TNF-αwere detected by radioimmunoassay method. SBP and MAP were directly measured by invasive method. Results:1. The SBP in LID group and ROP group are more stable than control group after lifesaver three minutes(P<0.01,P<0.05). The MAP in LID group is more stable than control group after lifesaver three minutes(P<0.05),and there is no significant difference between LID group and ROP group(P>0.05).2. The BG in all patients increased significantly at T4 and T5(P<0.01). The BG in ROP group increased more slowly than control group at T4 and T5(P<0.05),and there is no significant difference between LID group and ROP group(P>0.05).3. The Cor in all patients is no difference at T1 and T2. There is significant difference between LID group and control group(P<0.05),and there is no significant difference between LID group and ROP group(P>0.05).4. The IL-1βin all patients increased significantly,and it increased more significantly after CPB than before CPB(P<0.05). The IL-1βin LID group is lower than control group at T4 and T5(P<0.05). The IL-1βin ROP group is lower than control group at T5,and there is no significant difference between LID group and ROP group(P>0.05).5. The IL-6 in all patients increased significantly,and there is no significant difference at T1,T2 and T3. The IL-1βincreased higher at T4 and T5 after CPB than before CPB. The IL-1βin LID group and ROP group are lower than control group at T4 and T5(P<0.05),and there is no significant difference between LID group and ROP group(P>0.05).6. The TNF-αin all patients increased significantly,and there is no significant difference at T1,T2 and T3(P>0.05). The TNF-αincreased higher at T4 and T5 after CPB than before CPB. The TNF-αin LID group and ROP group are lower than control group at T4 and T5(P<0.05),and there is no significant difference between LID group and ROP group(P>0.05).Conelusion:1. SGB may mitigate cardiovascular responses induced by tracheal intubation.2. CPB may make BG highten significantly,and SGB can lower BG during CPB.3. With stringent state before surgery,the Cor of the patients increased abnormal. SGB may reduce the stress response to CPB,and make the plasma concentrations of Cor decline. 4. As the stress response of the surgery and CPB,the inflammatory reaction is induced,and inflammatory cytokine has increased in early stage. SGB may lower the plasma concentrations of inflammatory cytokine,then reduce the inflammatory reaction efficaciously.5. ROP will have the same block effect as LID on SGB. However the effect of long-term may be further studied.