Effect Of Sgb On Cerebral Metabolism In Cardiopulmonary Bypass And Postoperation Cognitive Function

Objective:To investigate the effects of stellate ganglion block（SGB）on brain metabolism during cardiopulmonary bypass and the postoperative cognitive function and the time of first awakening.Methods:Forty ASAⅡorⅢand NYHKⅡorⅢpatients aged 30 years old to 55 years old,weighting 45kg-75kg,undergoing valve replacement in cardiopulmonary bypass were randomly divided into 2 groups（n=20）,stellate ganglion block（S group）and control group（C group）:both group were catheterized right internal jugular vein.Stellate ganglion block group（S group）received right SGB by 0.25%ropivacaine 8ml,and the evidence of block is the present of Horner’s syndrome.Started anesthesia induced with midazolam,etomidate,fentanyl,cisatracurium at 15 minute after SGB.The control group（C group）started anesthesia induce directly.Anaesthesia of both group was maintained with propofol,midazolam,dexmedetomidine,cisatracurium,fentanyl,and sevoflurane,keep BIS between 35 to 60,MAP between 50mmHg to 90mmHg.SjvO₂,Da-jv O₂,CEO₂,Glu,Ga-jv,and rScO₂ were recorded immediately after right internal jugular vein catheterized（T0）,After the completion of the skin incision（T1）,15mins after the first infusion of cold blood cardioplegia was completed（T2）,at the cardiopulmonary bypass ended（T3）,and1h after the cardiopulmonary bypass ended（T4）.Measured patients’cognitive function at 1 day before surgery,1 day after surgery,and 5 days after surgery through MMSE,And recorded the time of first awakening.Result:SjvO₂、rScO₂、CEO₂、Da-jvO₂、Ga-jv of both group had no statistical significant difference at T0,（P>0.05）.SjvO₂ and rScO₂ of S group were higher than those of group C,while Ga-jv,Da-jv O₂,and CEO₂ were lower than those of group C at T1-T4.It had statistically significant difference,（P<0.05）.Sjv O₂ and rScO₂ of both group were peaked at T2,while Ga-jvand CEO₂ dropped to lowest at this point.The blood glucose in both groups increased gradually during CPB and reached the highest point in T4.The blood glucose of group S at T3 and T4 were lower than those of group C,and the difference was statistically significant,（P<0.05）.The MMSE score of 1 day before surgery was not statistical significant difference between group S and C,While MMSE score in both group was lower at the the first postoperative day than at before.MMSE score in group C at the first postoperative day and the fifth postoperative day are lower than those in group S,and the difference was statistically significant,（P<0.05）.There was no statistically significant difference between the two groups in the time of first awakening.Conclusion:SGBcanimprovecerebraloxygendeliveryand consumption balance,alleviate the increase of blood glucose of the patients undergoing valve replacement in cardiopulmonary bypass.It have a few positive effects on cerebral protection.