Stress Effect Of Stellate Ganglion Block On Patients With Heart Valve Replacement

Objective:To investigate the effect of right ganglia block(SGB)on stress factors in patients undergoing cardiopulmonary bypass(CBP)with heart valve replacement(HVR).Methods: From January 2019 to February 2020,40 patients,aged 25-60 years old,with preoperative(NYHA)cardiac function class II-III,preoperative ASA class II-III,EF > 35%,were enrolled in the study.All patients had informed consent and signed relevant informed consent before operation.All the patients in the group met the above conditions.The patients in the group were randomly divided into SGB group(s group)and control group(C group).The right SGB was anesthetized under the guidance of ultrasound in group s,and the anesthesia in group C was directly induced by conventional anesthesia.Radial artery puncture was performed in both groups.In the SGB group(s group),the right SGB was guided by ultrasound,and the standard of successful block was Horner’s syndrome(reduction of the right pupil,sunken eyeball,ptosis of the upper eyelid,lack of sweat on the right face),or the skin temperature of the right upper limb increased,the right face flushed,conjunctival congestion and other symptoms.One or more of the above symptoms proved the success of SGB on the right side.Ten minutes after SGB was successful,the anesthesia drugs were midazolam,etomidate,fentanyl and cisatracurium.The control group(Group C)was intubated normally.In group s and C,the anesthesia depth was maintained at 40-60 BIS and the mean arterial pressure(map)was maintained at 60mmhg-90 mm Hg.The systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(map),heart rate(HR)of the patients were recorded before anesthesia induction(T0),10 minutes after intubation(T1),30 minutes after cardiopulmonary bypass(T2),60 minutes after operation(T3),and blood glucose(Glu),cortisol(COR),insulin(INS)were measured.Results: At T0,there was no significant difference in blood glucose,cortisol and insulin levels between the two groups(P > 0.05).However,there was no significant difference in the value of blood glucose between the two groups at time T1(P > 0.05).The level of blood glucose at time T2 and T3 was higher than that at time t0.The level of blood glucose at time T2 and T3 in group s was lower than that in group C(P < 0.05).Compared with T0,the blood insulin level of T1,T2 and T3 in group s was higher than that in group C(P <0.05).The level of cortisol in blood at T1 and T2 was lower than that at T0,and the level of cortisol at T3 was higher than that at t0.However,at T1,T2 and T3,the level of cortisol in group s was lower than that in group C,which was statistically significant(P < 0.05).Conclusion: Valve replacement under cardiopulmonary bypass can lead to great stress response and bring adverse effects on patients’ postoperative recovery.SGB can stabilize the hemodynamic level of patients.Reduce the stress level of patients,reduce the perioperative blood glucose and cortisol level,and strengthen the release of insulin in patients’ blood.