| BackgroundIntracranial aneurysms are abnormal aneurysmal bulges from the vascular wall ofintracranial arteries.Clinically,intracranial aneurysm is the primary cause of subarachnoid hemorrhage,and the mortality rate of subarachnoid hemorrhage is 25%～60%,and the disability rate is close to 50%.At present,intracranial aneurysm clipping is a treatment method with mature technology,high reliability and low cost.The probability of complete clipping is as high as 90%at one time.However,complications such as cerebral vasospasm,brain edema,cranial infarction and intracranial infection may occur after intracranial aneurysm clipping,which seriously affect the health and life safety of patients.The researches show that stellate ganglion block can inhibit sympathetic nerve excitation,expand blood vessels,increase blood flow,improve brain injury microenvironment and play a role in brain protection,but there are few reports on brain protection in patients undergoing intracranial aneurysm clipping.ObjectiveTo investigate the brain protective effect of stellate ganglion block on patients after intracranial aneurysm clipping,so as to provide reference for the clinical application of stellate ganglion block in brain protection.MethodsA total of 86 patients who were diagnosed intracranial aneurysms with subarachnoid hemorrhage and requiring intracranial aneurysm of clipping treatment in our hospital from October 2020 to February 2022 were selected,and the patients were divided into control group and observation group randomly by the method of random number table,43patients who underwent routine general anesthesia were the control group,and 43 patients who underwent routine general anesthesia combined with stellate ganglion block were the observation group.For the observation group,stellate ganglion block was performed on the affected side before anesthesia induction.For the observation group,stellate ganglion block was performed on the affected side under ultrasound guidance before anesthesia induction,and 8 m L of ropivacaine with a concentration of 0.25%was injected.After 5-10minutes of block,if Horner syndrome can be observed,the block is successful.Stellate ganglion block was not performed in the control group.After entering the operating room is T0,the end of operation is T1,4 hours after operation is T2,12 hours after operation is T3,and 24 hours after operation is T4.The indexs such as cerebral hemodynamics,endothelin ET-1（Endothelin-1,ET-1）,inflammatory factor IL-6（Interleukin-6,IL-6）,neuron specific enolase NSE（Neuron Specific Enolase,NSE）,serum S100βprotein in T1～T4 and the incidence of complications 3 days after operation of the patients were compared to comprehensively evaluate the cerebroprotective effect of stellate ganglion blockade in patients undergoing intracranial aneurysm clipping.Results1.Cerebral hemodynamics（1）Intra group comparison:Compared with T0 time,the mean blood flow velocities of MCA（Middle Cerebral Artery,MCA）、ACA（Anterior Cerebral Artery,ACA）and PCA（Pos-terior Cerebral Artery,PCA）of the patients in the two groups in T1,T2,T3 and T4 time were significantly lower（P<0.05）.The mean blood flow velocities of MCA,ACA and PCA of the patients in the two groups decreased at T1 and T2,and increased at T3 and T4gradually.（2）Comparison between groups:At T0 time,the mean blood flow velocity of MCA,ACA and PCA of the patients between the two groups is no significant difference（P>0.05）.At T1,T2,T3 and T4,the mean blood flow velocities of MCA,ACA and PCA of the patients in the observation group were significantly lower than those in the control group（P<0.05）.2.Endothelin 1（ET-1）（1）Intra group comparison:Compared with T0 time,ET-1 of the patients of the two groups declined noticeablely in T1,T2,T3 and T4 time（P<0.05）.ET-1 of the patients in the both groups declined at T1 and increased by degrees at T2,T3 and T4（P<0.05）.（2）Comparison between groups:At T0 time,there was no significant difference in ET-1of the patients in the both groups（P>0.05）.At T1,T2,T3 and T4,ET-1 of the patients in the control group was significantly higher than those in the observation group（P<0.05）.3.Inflammatory factor 6（IL-6）（1）Intra group comparison:Compared with T0 time,IL-6 of the patients of the two groups in T1,T2,T3 and T4 time declined significantly（P<0.05）.IL-6 of the patients of the both groups increased at T1 and gradually decreased at T2,T3 and T4（P<0.05）.（2）Comparison between groups:The two groups had no significant difference in IL-6 at T0（P>0.05）.At T1,T2,T3 and T4,IL-6 of the patients in the observation group was noticely lower than those in the control group（P<0.05）.4.Neuron specific enolase（NSE）（1）Intra group comparison:Compared with T0 time,NSE of the patients of the two groups in T1,T2,T3 and T4 time increased continuously,and there was statistical significance（P<0.05）.（2）Comparison between groups:At T0 time,there was no significant difference in NSE of the patients in the both groups（P>0.05）.At T1,T2,T3 and T4,NSE in the observation group was higher than that in the control group,and the difference had statistical significance（P<0.05）.5.Serum S100βprotein（1）Intra group comparison:Compared with T0 time,at T1,T2,T3 and T4 time,S100βof patients in the control group increased continuously,the difference had statistically significant（P<0.05）,S100βof the patients in the observation group increased continuously at T1,T2 and T3 time,there was no statistical significance（P>0.05）,S100βof the patients in the observation group at T4 time decreased compared with at T3 time,and the change trend of S100βwas stable.（2）Comparison between groups:At T0 time,there was no significant difference in S100βin the both groups（P>0.05）.At T1 time,S100βin the observation group was lower than that in the control group,and the difference had no statistically significant（P>0.05）.At T2,T3 and T4 time,S100βin the observation group was lower than that in the control group,and the difference had statistically significant（P<0.05）.6.Incidence of complicationsThe total incidence of postoperative cerebral vasospasm,cerebral edema,cerebral infarction and intracranial infection was 27.9%in the observation group and 67.4%in the control group.The occurrence of complications after the operation in the control group was higher than that in the observation group significantly.ConclusionPerforming stellate ganglion block before intracranial aneurysm clipping can stabilize cerebral hemodynamics,reduce the level of endothelin ET-1,inhibit the release of inflammatory factor IL-6,reduce neuron specific enolase NSE and serum S100βprotein,improve effectively the local brain microenvironment,reduce the incidence of postoperative complications,and play a role in brain protection. |
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