超声引导下星状神经节阻滞治疗期间失眠障碍患者血流动力学和心率变异性变化的动态观察OA
Dynamic changes in hemodynamics and heart rate variability during ultrasound-guided stellate ganglion block in patients with insomnia disorder
目的 评价超声引导下左侧或右侧星状神经节阻滞(SGB)过程中失眠障碍患者血流动力学和心率变异性(HRV)的动态变化.方法 采用随机盲法将20例中青年研究对象均衡分配至左侧SGB组(L组)与右侧SGB组(R组),两组患者均采用在超声引导下使用0.8％利多卡因3 mL对星状神经节进行局部浸润,记录两组患者治疗前(T0)、治疗后即刻(P1)、治疗后2min(P2)、4 min(P3)、6 min(P4)、8 min(P5)连续动态的血流动力学变化,包括脉率(PR)、平均动脉压(MAP)、每搏输出量(SV)、每搏输出指数(SI)、心输出量(CO)和全身血管阻力指数(SVRI),同时记录SGB前、后的HRV参数,包括低频成分(LF)、高频成分(HF)、LF/HF比值;并于SGB前及SGB后7 d进行匹兹堡睡眠质量指数(PSQI)评分,比较两组患者头晕、恶心呕吐及呼吸抑制等不良反应的发生情况.结果 SGB治疗期间,两组患者血流动力学参数较SGB前基线值均未出现明显波动,R组SGB后MAP呈下降趋势(1.2％～2.7％),L组SGB后PR有下降(0.4％～2.3％),L组SGB后CO均降低(3.4％),两组间差异均无统计学意义(P＞0.05),L组SGB后LF/HF比值有下降趋势(5.1％),而R组SGB后LF/HF比值有升高趋势(51.3％),但组间差异亦无统计学意义(P＞0.05),两组PSQI评分均较SGB前显著改善(P＜0.0001).两组均未见头晕、恶心、呕吐、呼吸抑制及声音嘶哑等不良反应.结论 对于失眠障碍患者,超声引导下单侧SGB治疗期间血流动力学平稳,可调节交感-副交感神经平衡,对睡眠质量产生积极的改善作用,本SGB方法安全可靠,可在临床推广应用.
Objective To evaluate the dynamic changes in hemodynamic parameters and heart rate variability(HRV)during ultrasound-guided stellate ganglion block(SGB)on either the left or right side in patients with insomnia disorder.Methods Twenty young and middle-aged participants with insomnia disorder were randomly assigned in a blinded manner to a left-sided SGB group(Group L)or a right-sided SGB group(Group R).In both groups,3 mL of 0.8％lidocaine was injected for ultrasound-guided stellate ganglion block.Hemodynamic parameters,including pulse rate(PR),mean arterial pressure(MAP),stroke volume(SV),stroke index(SI),cardiac output(CO),and systemic vascular resistance index(SVRI),were continuously recorded at baseline before SGB(T0),immediately after SGB(P1),and at 2 min(P2),4 min(P3),6 min(P4),and 8 min(P5)after the procedure.HRV parameters,including low-frequency power(LF),high-frequency power(HF),and the LF/HF ratio,were recorded before and after SGB.Sleep quality was assessed using the Pittsburgh Sleep Quality Index(PSQI)before SGB and 7 days after the procedure.Adverse events such as dizziness,nausea,vomiting,and respiratory depression were also documented.Results During SGB treatment,no significant fluctuations in hemodynamic parameters were observed in either group compared with base-line values.After SGB,MAP in Group R showed a slight decreasing trend(1.2％-2.7％),while PR in Group L de-creased modestly(0.4％-2.3％),and CO in Group L decreased by approximately 3.4％.However,these differences were not statistically significant between groups(P＞0.05).Following SGB,the LF/HF ratio tended to decrease in Group L(5.1％),whereas an increasing trend was observed in Group R(51.3％);however,the between-group difference was not statistically significant(P＞0.05).PSQI scores were significantly improved in both groups 7 days after SGB com-pared with baseline(P＜0.000 1).No adverse events,including dizziness,nausea,vomiting,respiratory depression,or hoarseness,were observed in either group.Conclusion In patients with insomnia disorder,ultrasound-guided unilater-al stellate ganglion block produces stable hemodynamic responses while modulating the balance between sympathetic and parasympathetic nervous activity,thereby improving sleep quality.This SGB technique appears safe and reliable and may be suitable for broader clinical application.
曾祝文;黄鸿锐;严笑;孙传雯;刘建华;应彦璐
广州市第一人民医院、华南理工大学附属第二医院麻醉睡眠中心(广东 广州 510180)广州市第一人民医院、华南理工大学附属第二医院麻醉睡眠中心(广东 广州 510180)广州市中西医结合医院麻醉科(广东 广州 510800)广州市第一人民医院、华南理工大学附属第二医院麻醉睡眠中心(广东 广州 510180)南方医科大学第五附属医院麻醉科(广东 广州 510900)广州市第一人民医院、华南理工大学附属第二医院麻醉睡眠中心(广东 广州 510180)
医药卫生
失眠障碍星状神经节阻滞血流动力学心率变异性
insomnia disorderstellate ganglion blockhemodynamicsheart rate variability
《广东医学》 2026 (3)
349-354,6
广州市科技计划项目(2024A03J0964)
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