Effects Of Stellate Ganglion Block On Cerebral Oxygen Metabolism And Postoperative Cognitive Function In Patients With Previous Ischemic Stroke

Objective:To observe the effect of stellate ganglion block(SGB)on cerebral oxygen metabolism and postoperative cognitive function in patients with previous ischemic stroke,and to explore its possible mechanisms.Method:60 patients with previous history of ischemic stroke were randomly divided into two groups: block group(S group)and control group(C group),30 cases in each group.There was no significant difference in general conditions between the two groups,including age,sex,weight,ASA grade and operation duration(P > 0.05).Both groups were given general anesthesia with double-lumen endotracheal intubation and maintained under combined intravenous and inhalation anesthesia.Group S received ultrasound-guided left SGB with 0.5% ropivacaine 7 ml before induction of general anesthesia.Group C received no special treatment.Blood samples of jugular vein were collected 5 ml before SGB(T0),at T1 after anesthesia,0.5 hours after operation(T2)and at T3 at the end of operation.The levels of VILIP1 and NR2 polypeptide in serum were measured by ELISA,and the oxygen saturation(SjvO2)of mixed cerebral vein blood at each time point was measured by blood gas analysis.Pulse oxygen saturation(SPO2),heart rate(HR)and mean arterial blood pressure(MAP)were measured and recorded at 4 time points in both groups.One day before operation,one day after operation and three days after operation were selected as evaluation points.The cognitive function of the two groups was assessed with the Mini Mental State Assessment Scale(MMSE).The MMSE scores were recorded and the collected data were analyzed and compared.Result:1.Comparisons of respiratory and circulatory indexes at different time points in group S and C: SpO2 and T0 in group C increased significantly at T1,T2 and T3 time points(P < 0.05),HR at T1,T2 and T3 time points also increased significantly at T0 time points(P < 0.05).There was no significant difference between MAP at T1 time point and T0 time point,while MAP at T2 and T3 time points was significantly lower than that at T0 time point(P < 0.05).SpO2 and T0 in group S increased significantly at T1,T2 and T3 time points(P < 0.05),HR and T0 time points at T1,T2 and T3 time points had no significant difference,but MAP and T0 time points at T1 and T2 time points had significant decrease(P < 0.05).There was no significant difference in SpO2 between group C and group S at each time point.HR at T1,T2 and T3 in group C was significantly higher than that in group S(P < 0.05),MAP level at T1 was significantly higher than that in group S(P < 0.05),while MAP level at T2 and T3 was significantly lower than that in group S(P < 0.05).2.Comparison of serological markers at different time points: SjvO2 and T0 in group C at T1,T2 and T3 time points were significantly lower(P < 0.05),while VILIP1 and NR2 polypeptide levels were significantly higher(P < 0.05).There was no significant difference between SjvO2 and T0 at T1,SjvO2 and T0 at T2 and T3(P < 0.05),and there was no significant difference between VILIP1 and NR2 polypeptide levels at T1,T2 and T3.Compared with group S,SjvO2 in group C decreased significantly at T1,T2 and T3(P < 0.05),while VILIP1 and NR2 polypeptide levels increased significantly(P < 0.05).3.Comparison of MMSE score and POCD occurrence: There was no significant difference in MMSE score between the two groups on the first day before operation(P > 0.05).The MMSE score of group C on the first and third day after operation was significantly lower than that of group C on the first and third day after operation(P < 0.05).There was no significant difference in the MMSE score of group S on the first and third day after operation compared with that of group S on the first and third day after operation(P < 0.05).There was no POCD in both groups one day before operation,and the incidence of POCD in group S was significantly lower than that in group C(P < 0.05).Conclusion:1.Stellate ganglion block makes perioperative hemodynamics more stable in patients with previous ischemic stroke.2.Stellate ganglion block improves perioperative cerebral blood flow and cerebral oxygen metabolism in patients with previous ischemic stroke.3.Stellate ganglion block reduces the incidence of cognitive impairment in patients with previous ischemic stroke.