The Effect Of Stellate Ganglion Block Combined With General Anesthesia On Perioperative Cognitive Function In Patients Undergoing The Slectroresection Of Prostate

BackgroundSlectroresection of prostate and anesthesia stimulation can cause inflammatory and stress responses,and this stress response can cause vasoconstriction,sympathetic nerve excitement,resulting in abnormal circulatory function,tissue hypoxia and ischemia,and then abnormalities in the immune system,endocrine system,and nervous system,so reducing the degree of inflammatory stress caused by surgery and anesthesia is an important part of ensuring the safety of surgical treatment and postoperative recovery.In recent years,the application value of stellate ganglion block?SGB?in surgical treatment has been generally valued,it is believed that it can promote the production of anti-inflammatory cytokines and inhibit the secretion of early pro-inflammatory cytokines,thereby reducing the degree of inflammatory stress response.ObjectiveTo explore the effect of stellate ganglion block?SGB?combined with general anesthesia on perioperative cognitive function in patients undergoing electrosurgical prostatectomy,with a view to providing a reference for the selection of the best anesthesia plan during disease operation.MethodForty patients with slectroresection of prostate in our hospital?March 2018-March2019?were selected and divided into a control group?n=20?and a study group?n=20?according to the random number table method.Both groups underwent general anesthesia,and the study group underwent SGB before induction of anesthesia.The hemodynamic indexes[mean arterial pressure?MAP?,heart rate?HR?,blood oxygen saturation?SpO₂?,partial pressure of carbon dioxide?PaCO₂?]level,cerebral oxygen metabolism indicators[brain oxygen uptake rate?CEO₂?,and the difference of oxygen content in the bulb of radial internal jugular vein?Da-jvO₂?]in different time periods[before anesthesia?T₀?,after skin removal?T₁?,immediately after surgery?T₂?,30 minutes after surgery?T₃?],perioperative status[operation time,intraoperative bleeding volume,infusion volume,urine volume,dosage of anesthetic drugs?sevoflurane,remifentanil?],serum levels of central nervous specific protein?S100??and cognitive function?the Mental State Examination,MMSE?scores before and after surgery at 6 h,24 h,and 72 h,adverse reactions?vomiting and nausea,abnormal heart rate,restlessness,respiratory depression?and the incidence of perioperative neurocognitive disorder?PND?at 1 week after surgery in the two groups was counted.Result1.Hemodynamics:There was no significant difference in MAP,HR,SpO₂,PaCO₂between the two groups at T₀?P>0.05?;there was no statistically significant difference between the MAP,HR and T0 periods of the study group in the T₁,T₂,and T₃ periods?P>0.05?,but the MAP and HR of the control group were higher than those in the T₀ period,and the difference was statistically significant?P<0.05?;during the period of T₁,T₂ and T₃,the MAP and HR of the study group were lower than those of the control group,the difference was statistically significant?P<0.05?;there was no statistically significant difference in SpO₂,PaCO₂ and T₀ between the two groups in T₁,T₂,and T₃ periods?P>0.05?.2.Cerebral oxygen metabolism:There was no statistically significant difference between CEO₂ and Da-jvO₂ in the two groups at T₀?P>0.05?;the CEO₂ and Da-jvO₂ of the two groups in T₁,T₂ and T₃ were lower than those in T₀,and the study group was lower than the control group,and the difference was statistically significant?P<0.05?.3.Perioperative status:There was no significant difference in the operation time,intraoperative blood loss,infusion volume,and urine volume of the study group compared with the control group?P>0.05?,the dosage of sevoflurane and remifentanil in the study group was less than that in the control group,and the difference was statistically significant?P<0.05?.4.Serum S100?protein:there was no significant difference in serum S100?protein levels between the two groups before surgery?P>0.05?,the levels of serum S100?protein in the two groups increased at 6 h,24 h,and 72 h after surgery compared with those before surgery,and the difference was statistically significant?P<0.05?,serum S100?protein levels began to decrease at 24 h after operation in both groups,and serum S100?protein levels in the study group at 6 h,24 h,and 72 h after surgery were lower than those in the control group,and the difference was statistically significant?P<0.05?.5.Cognitive function:There was no significant difference in MMSE score between the two groups before surgery?P>0.05?,the MMSE scores of the two groups at 6 h,24 h,and 72 h after surgery were lower than those before surgery,but the study group was higher than the control group,and the difference was statistically significant?P<0.05?.6.Adverse reactions and PND:The incidence of adverse reactions in the study group?10.00%?was lower than that in the control group?30.00%?,but the difference was not statistically significant?P>0.05?,the incidence of PND in the study group?0.00%?was lower than that in the control group?30.00%?,and the difference was statistically significant?P<0.05?.ConclusionIn the slectroresection of prostate,general anesthesia combined with ultrasound-guided SGB can reduce the degree of cognitive impairment and reduce the incidence of PND.