Effect Of Stellate Ganglion Block On Thrombosis After Upper Limb Angiosynthesis Experimental And Clinical Studies

The local microenvironment after vascular anastomosis is more changeable,because its local hemodynamics and fluid dynamics are unstable,the risk of thrombosis is very high.Combined with previous related studies on SGB,using its unique physiological characteristics,through clinical trials and animal experiments to explore the effect of SGB on thrombosis after vascular anastomosis of upper limb vascular injury.This study is mainly composed of clinical and animal experiments.Part I: Effect of stellate ganglion block on thrombosis of rabbit SGB model:Subjects: 60 adult rabbits,41 males,19 females,weight(3.2±0.3)kg.Animal modelling: A rabbit animal SGB model was model was prepared,and the pupil dilation,ptosis and eye fissure decrease proved the model was successful.Experimental methods: The experimental animals were randomly divided into three groups,modeling group,control group and block group(20 cases each).Modeling group: SGB modeling,anaesthetic intervention,not off-line anastomosis;Control group: SGB modeling,no anesthetic intervention,anastomosis was performed.Block group: SGB modeling,anaesthetic intervention,anastomosis of severed vessels.Normal saline 1.0 ml/12 h,block group 0.25% bupivacaine 1.0 ml/12 h, normal saline group and block group performed brachial artery dissection anastomosis 3 d after modeling.The supernatantwas-80? frozen at 2 ml,30r/min centrifugation and 10 min,at each time point before and immediately after the model-making.Observation indicators: 1)doppler ultrasound detection: brachial artery diameter,peak systolic velocity(PSV),end-diastolic velocity(EDV),acceleration(AT)and vascular resistance index(RI)were measured at 3 cm of distal anastomosis at rest state before operation and 4 time points after operation.2)electron microscope observation :24h,after the original incision exposed anastomosis,take the anastomotic mouth far and near end 0.5 cm brachial artery,rinse,dry,fixed scanning electron microscope observation and calculate the anastomotic suture fibrinogen,platelet coverage area.3)electron microscope observation results: postoperative electron microscope observation showed that the area of fibrinogen and platelet coverage at anastomotic suture of block group was smaller than that of control group.4)ELISA method was used to detect the expression of TNF-?,IL-6 in serum at each time point.5)determination of malondialdehyde(MDA),superoxide dismutase(SOD),norepinephrine(NE),and nitrous oxide(NO)by biochemical assays by molecular biology.Statistical analysis: The normal distribution of statistical variables is expressed as mean ± standard deviation(?±S),and the median and quartile spacing is not in accordance with the normal distribution.The counting data in statistical variables are expressed by rate and composition ratio.the counting data were compared between groups using ?2 or Fisher accurate tests.ANOVA analysis and LSD-t test(normal distribution)or Kruskal-Wallistest(non-normal distribution)were used to compare the differences between the two groups.hitney Utest(non-normal distribution).The RM-ANOVA variance analysis was used for the observation comparison of continuous time points,and the Bonfonni was used for statistical correction,and 95% CI.was calculated.All hypothesis tests were performed by bilateral test,p<0.05 was considered statistically significant.Data processing and statistical analysis using SPSS25.0 software.Results: The control group showed high expression of IL-6 and TNF-?,while the SGB treatment group showed varying degrees of decrease.TNF-? expression increased significantly,more significantly in the SGB group,and lasted longer.The control group IL-6 increased and IL-6 increased after SGB treatment,but the TNF-? protein level did not change significantly.SGB may occur to inhibit early hyperinflammatory responses,suggesting that SGB may be involved in the regulation of immune system dysfunction.Main findings and conclusions: Doppler spectrum detection results: in the resting state,the brachial artery diameter of the block group was significantly expanded compared with the control group and the modeling group,and the PSV,EDV was increased.AT,RI there was no significant difference between the three groups.The PSV,AT,PI of h control group and block group were significantly lower than those of the model group.The results showed that the coverage area of fibrinogen and platelet at anastomotic suture of block group was smaller than that of control group.Biochemical test: before block,delay,4h,12 h,24h time point compared with the modeling group,the TNF-?,NE,NO level of block group and control group began to increase at 4h after operation,and the IL-6,MDA,SOD level began to increase at 12 h and continued to 24 h..The average water of each factor in block group was lower than that in control group,and the difference was statistically significant.The main findings and conclusions of this study are as follows: 1)reveal the changes of hemodynamics and fluid dynamics of proximal vessels during thrombosis after vascular anastomosis.2)reveal the expression of inflammatory factors such as TNF-?,IL-6 in blood at different time points of local microcirculation after vascular anastomosis.3)reveal the effect of SGB on thrombosis after brachial artery anastomosis and provide new ideas for effective intervention therapy for early prevention of thrombosis.4)the changes of inflammatory response were analyzed by detecting the levels of inflammatory factors before and after stellate ganglion block group compared with IL-6.5)the effect of stellate ganglion block on related indexes(NE,NO,IL-6,MDA,SOD and other indexes),analyze whether SGB can reduce the inflammatory response after anastomosis of vascular injury by the effect of sympathetic axis.Taken together,this study suggests that SGB may mainly benefit from the effects of stellate ganglion block on the sympathetic and circulatory systems.not only can increase the local blood flow after brachial artery anastomosis,but also can mediate the positive effect of thrombosis after vascular anastomosis by regulating inflammatory factors,inhibiting local microenvironment changes such as sympathetic nerve,and improving the clinical outcome.To the best of our knowledge,SGB application to brachial artery anastomosis has never been reported.notably,although the relationship between pain,microcirculation,and autonomic nervous system remains unclear,sympathetic-associated brachial artery regions innervate sensation and microcirculation has been identified in previous studies,which may also provide an explanation for the conclusions of this study.Therefore,it can be inferred that it may be the effect of stellate ganglion block.Part II: Effect of Stellate Ganglion Block on Thrombosis of Forearm after AngiosynthesisSubject: A total of 40 patients(26 males and 14 females;age range 19-65 years,mean 36.72±3.71 years)underwent vascular anastomosis in the emergency department of forearm vascular injury from December 2013 to December 2019.Research methods: Patients in the group were randomly divided into two groups by randomized grouping,the control group(N=20)and the block group(N=20).Both groups completed general anesthesia.SGB was performed before operation in the block group(ultrasound-guided cervical approach 7 SGB).Routine preoperative operation(no SGB)in the control group.Postoperative analgesia with automatic intravenous analgesia pump(no background measurement).Observation indicators: 1)SGB success marks: the temperature of the ear margin of the block side was 0.5? higher than that of the contralateral side.2)demographic and clinical characteristics: sex,age(age),residential attributes,economic status,smoking history;3)admission parameters included albumin(g/L),absolute lymphocyte value(109/L),hemoglobin(g/L),cholinesterase(U/L)and erythrocyte count(1012/L).4)complications include hypertension,hyperlipidemia,diabetes,stroke and coronary heart disease;5)time data: injury to admission(h);6)related parameters: hospital stay(days),treatment costs(10,000 yuan);7)brachial artery ultrasound: brachial artery diameter(R),systolic maximum velocity(PSV),end-diastolic velocity(EDV),acceleration(AT)and vascular resistance index(RI)were observed before block(base value),immediately after block,4h,24 h postoperatively.8)biochemical parameters: preoperative,postoperative 4h,24 h and 48 h of each time node TNF-?,IL-6,MDA,SOD,NE and NO content.9)postoperative analgesics consumption(ng/kg): record postoperative analgesic pump anesthetic dosage and compression times.In this study,nerve block fluid was continuously pumped by electronic analgesic pump,the injection rate was accurate,and the patients were self-controlled.simultaneous recording of VAS score: recording of pain visual analogue score(VAS score: preoperative and postoperative).10)Fingertip skin temperature(?): EP605 digital skin barrier skin thermometer(shanghai yilian science and education equipment company)was used to measure the skin temperature of the distal end after vascular anastomosis.11)Fingertip pulse oxygen saturation(mm Hg),vascular crisis(%),secondary detection(%);12)Survival rate after anastomosis: The survival of blood vessels after anastomosis is determined according to the evaluation criteria of vascular survival after anastomosis,that is,postoperative blood flow,color,temperature and other indicators are the same as normal.Statistical analysis: The normal distribution is expressed as mean±standard deviation(?±S)in the measurement data of statistical variables,and median and quartile spacing accordance with the normal distribution.The counting data in statistical variables are expressed by rate and composition ratio.Statistical variables count data between groups with ?2 or Fisher accurate test.the inter-group differences of the measured data were analyzed Student's t test(normal distribution)or Mann-Whitney U test(non-normal distribution).All hypothesis tests were performed using bilateral tests to calculate 95% confidence intervals(Confidence Interval,CI),p <0.05 were considered statistically significant.Using SPSS25.0 software(SPSS Inc.Chicago,IL,USA)row data processing and statistical analysis.Findings and conclusions: Doppler spectrum detection results: in the resting state,the brachial artery diameter of the block group was significantly expanded compared with the control group and the modeling group,and the PSV,EDV was increased.AT,RI there was no significant difference between the three groups.The PSV,AT,PI of h control group and block group were significantly lower than those of the model group.Biochemical test: TNF-?,NE,NO levels of preoperative,postoperative 4h,24 h and 48 h time nodes began to increase after operation,IL-6,MDA,SOD levels began to increase at 24 h,and continued to 48 h..the level of each factor in the block group was lower than that in the control group,and the difference was statistically significant.