Objective: To explore the effects of ultrasound-guided stellate ganglion block (SGB) on perioperative stress response, gastrointestinal hormones and postoperative gastrointestinal function recovery in patients undergoing laparoscopic radical gastrectomy for gastric cancer.
Methods: This study was conducted among 60 American Society of Anesthesiologists (ASA) class II-III patients with gastric cancer (regardless of gender, aged 35-75 years with BMI of 18.5-26 kg/m2) undergoing elective laparoscopic radical gastrectomy. The patients were randomized into experimental group (S group, n=30) and control group (NS group, n=30). In S group, SGB at the C6 level of the right cervical spine was performed under ultrasound guidance 15 min before induction of anesthesia by injection of 7 mL 0.5% ropivacaine; the patients in NS group received injections of normal saline in the same manner. Peripheral venous blood samples were collected before SGB (T1), after surgery (T2), and on the 2nd and 6th days after surgery (T3 and T4) for determination of the levels of motitin (MOT), vasoactive intestinal peptide (VIP), cortisol (COR), and blood glucose (GLU). Intraoperative usage of sufentanil, recovery rate of intestinal sounds at 36, 48, 60, 72, 84 and 96 h after operation and the time of first passage of flatus were recorded and compared between the two groups.
Results: There was no significant difference in the total amount of sufentanil consumption between the two groups. Compared with those in NS group, the patients in S group had significant lower COR and VIP levels (P < 0.05) and higher MOT level (P < 0.05) at T2, T3 and T4. Glu level at T2 and T3 was also significantly lower in S group (P < 0.05). The recovery rates of intestinal sounds at 36, 48, 60, 72 and 84 h after surgery were significantly higher (P < 0.05) and the time of the first passage of flatus was earlier in S group than in NS group (P < 0.05).
Conclusion: In patients with gastric cancer undergoing laparoscopic radical gastrectomy, ultrasound-guided SGB can reduce postoperative stress level, promote the recovery of gastrointestinal hormone secretion, and accelerate postoperative recovery of gastrointestinal functions.
目的: 探究超声引导下星状神经节阻滞（SGB）对腹腔镜下胃癌根治术患者围术期应激反应、胃肠激素和术后胃肠功能恢复的影响。
方法: 择期行腹腔镜胃癌根治术患者60例，性别不限，年龄35~75岁，BMI 18.5~26 kg/m2，ASA分组Ⅱ~Ⅲ级。采用随机数字表法将其分为实验组和对照组，各30例。实验组于麻醉诱导前15 min行超声引导下右侧C6水平SGB操作，注入0.5%罗哌卡因7 mL。对照组于同一部位注射生理盐水7 mL。选择SGB前（T1）、术毕（T2）、术后第2天（T3）、术后第6天（T4）时间点采集患者外周静脉血样，测定血中胃动素（MOT）、血管活性肠肽（VIP）、皮质醇（Cor）、血糖（Glu）水平；记录术中舒芬太尼使用量；记录术后36、48、60、72、84、96 h肠鸣音恢复率及首次排气时间。
结果: 与对照组相比较，两组舒芬太尼总用量差异无统计学意义；与对照组相比，实验组T2、T3、T4时点Cor水平较低，VIP水平较低，MOT水平较高（P < 0.05）。与对照组相比，实验组T2、T3时点Glu水平较低（P < 0.05）。与对照组相比，实验组术后36、48、60、72、84 h肠鸣音恢复率较高（P < 0.05），术后排气时间缩短（P < 0.05）。
结论: 超声引导下SGB可以减轻腹腔镜下胃癌根治术患者围术期应激水平，促进胃肠激素分泌水平恢复，加快术后胃肠功能快速恢复。
Keywords: gastric cancer; gastrointestinal function; gastrointestinal hormones; stellate ganglion block; stress response.