Effects Of Stellate Ganglion Block On Balance Between Cerebral Oxygen Delivery And Consumption And Gastric Intramucosal Phi In Intracranial Surgical Patients

Objective:To study the effects of right stellate ganglion Block on balance between cerebral oxygen delivery and consumption and gastric intramucosal PHi in intracranial surgical patients.Methods:Twenty patients scheduled for neurosurgery were randomly divided into 2 group (n=10 each):right stellate ganglion block group(SGB group) and control group(Control group). Hymodynamics indexe:mean blood pressure(MBP),heart rate(HR),blood pressure at jugular venous bulb(JBP) and these parameters of brain glucose and oxygen metabolism such as arterial blood glucose (BGa),the glucose content difference between arterial and jugular bulb(Da-jvBG),cerebral glucose extraction rate(BGER),arterial oxygen contents(CaO2),jugular bulb venous oxygen saturation(SjvO2),oxygen content difference between arterial and jugular bulb (Da-jvO2),cerebral oxygen extraction rate (CERO2) were observed at before intervention (TO),30 min after intervention befour anesthesia induction (T1),at 1hour during operation (T2),at the end of operation (T3) and at 10 min after tracheal extubation (T4)Forty patients with cerebral trauma undergoing emergency surgery were allocated to mild or moderate degree group (Q group) and severe degree group (Z group) according to Glasgow scores more or less than 8. The 20 cases in each group were furtherly randomly divided into stellate ganglion block subgroup (S subgroup) and control group (C subgroup). There were four subgroups (QS,QC,ZS,ZC) and 10 cases in each subgroup. When the patients was smooth after general anesthesia, the patients of QS and ZS subgroups or QC and ZC subgroups were given local injection at right stellate ganglion with 0.25% bupivacaine solution 10ml or NS 10ml. Gastric intramucosal PHi were compared before intervention (TO),at lhour during operation (T1),at the end of operation (T2) and at 1 hour after surgery (T3) Results:(1)HR of SGB group at T1-T4 was lower than that of control group. MAP and HR of SGB group at T4 was more stable than those of control group. The variation of JBP at both group showed identical.(2) Bga at control group was more steadily increased than that at SGB group. Similar changes of Da-jvBG and BGER were found:lower at T2, higher at T4.(3)The variation pattern of CaO2 at SGB group were similar to that at control group. SjvO2 at both group maintained at normal range, but the curve of SjvO2 at SGB group was lolated at upper side of the curve at control group. The curve of Da-jvO2 and CERO2 at SGB group was increased obviously, yet the curve at control group was decreased apparently (p<0.01)(4)QC subgroup at every time point had significantly higher pHi values than QC subgroup at corresponding time point. The pHi values of QS and ZS subgroup from T1 to T3 had significantly higher than those of the same subgroup at TO and those of each control QC and ZC subgroup at corresponding time point. As to the amplitude in the Phi increase, the ZS subgroup was superior to the QS subgroup.Conclusions:(1)SGB playing an important role in the brain functional recovery might owe to improve cerebral oxygen delivery to relief the vasopasm of cerebral vessels, but not strongly impact on glucose extraction.(2)Gastric intramucosal Phi values decreaces in patients with cerebral trauma and the decrease amplitude was related to the degree of cerebral trauma positively. SGB improves pHi values in an injury severity dependent manner.