文章摘要
超声引导下星状神经节阻滞对活体供肾者术后疲劳综合征的影响
Effect of ultrasound-guided stellate ganglion block on postoperative fatigue syndrome in living kidney donors
  
DOI：10.12089/jca.2025.07.002
中文关键词: 星状神经节阻滞  活体供肾者  肾移植  术后疲劳综合征
英文关键词: Stellate ganglion block  Living kidney donors  Kidney transplantation  Postoperative fatigue syndrome
基金项目:中央高校基本科研业务费专项资金资助（YD9110002015）
作者单位E-mail
葛震坤 230001,合肥市,中国科学技术大学附属第一医院（安徽省立医院）麻醉科  
伍启星 230001,合肥市,中国科学技术大学附属第一医院（安徽省立医院）麻醉科  
吴文杰 230001,合肥市,中国科学技术大学附属第一医院（安徽省立医院）麻醉科  
黄祥 230001,合肥市,中国科学技术大学附属第一医院（安徽省立医院）麻醉科  
康芳 230001,合肥市,中国科学技术大学附属第一医院（安徽省立医院）麻醉科  
李娟 230001,合肥市,中国科学技术大学附属第一医院（安徽省立医院）麻醉科 huamuzi1999@126.com 
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中文摘要:
      
目的：（SGB）对活体供肾者（LKD）术后疲劳综合征（POFS）的影响。
方法：选择2023年3月至2024年1月择期行活体肾移植术的LKD 64例，男31例，女33例，年龄≥18岁，BMI 18.5～28.0 kg/m2，ASA Ⅰ或Ⅱ级。采用随机数字表法将LKD分为两组：SGB组和对照组，每组32例。麻醉诱导前30 min，SGB组于超声引导下将0.25%罗哌卡因6 ml注入右侧星状神经节内；C组术前不行SGB操作。于术后1、3、7 d采用10项简明围术期疲劳评测量表（ICFS-10）评估疲劳情况。记录术后1、3、7 d失眠严重指数（ISI）和静息时VAS疼痛评分。于术前1 d和术后1 d检测血浆5-羟色胺（5-HT）、褪黑素（MT）、白细胞介素-6（IL-6）、白细胞介素-1β（IL-1β）和肿瘤坏死因子-α（TNF-α）浓度。记录术后1、3 d尿量，于术前1 d、术后1、3、7 d检测肌酐和尿素氮浓度。记录术后首次肛门排气时间、术后首次进食时间以及恶心、呕吐等术后不良反应的发生情况。术后3个月分别采用神经病理性疼痛量表（DN4）和ICFS-10评估神经病理性疼痛和POFS情况。
结果：与对照组比较，SGB组术后1、3、7 d ICFS-10评分、POFS发生率、中重度POFS比例明显降低（P<0.05），术后3、7 d ISI明显降低（P<0.05），术后1 d血浆5-HT、MT浓度明显升高，IL-6、IL-1β、TNF-α浓度明显降低（P<0.05），术后首次肛门排气时间、术后首次进食时间明显缩短（P<0.05）。两组术后不同时点静息时VAS疼痛评分、尿量、肌酐、尿素氮浓度，以及术后恶心、呕吐发生率、术后3个月DN4评分、ICFS-10评分、POFS发生率差异无统计学意义。
结论：超声引导下SGB能降低LKD的POFS发生率和严重程度，可能与减少炎性因子释放、增加血浆5-HT和MT含量、改善术后睡眠、促进术后肠道功能恢复有关。
英文摘要:
      
Objective: To investigate the effects of ultrasound-guided stellate ganglion block (SGB) on postoperative fatigue syndrome (POFS) in living kidney donors (LKDs).
Methods: Sixty-four LKDs undergoing elective living kidney transplantation between March 2023 and January 2024, 31 males and 33 females, aged ≥ 18 years, BMI 18.5-28.0 kg/m2, ASA physical status Ⅰ or Ⅱ, were enrolled in this study. The LKDs were randomly assigned to two groups using a random number table: the SGB group and the control group, 32 LKDs in each group. In the SGB group, 0.25% ropivacaine 6 ml was injected into the right stellate ganglion under ultrasound guidance 30 minutes before anesthesia induction. The control group did not receive SGB preoperatively. The fatigue status was evaluated by using the identity-consequence fatigue scale-10 (ICFS-10) 1, 3, and 7 days after the operation. The insomnia severity index (ISI) and VAS pain scores at rest were recorded 1, 3, and 7 days after the operation. The concentrations of plasma 5-hydroxytryptamine (5-HT), melatonin (MT), interleukin-6 (IL-6), interleukin-1β (IL-1β), and tumor necrosis factor-α (TNF-α) were detected 1 day before the operation and 1 day after the operation. The douleur neuropathique 4 questions (DN4) and ICFS-10 were respectively used 3 months after the operation to evaluate the status of neuropathic pain and POFS. The urine volume was recorded 1 day and 3 days after the operation. The concentrations of creatinine and urea nitrogen were detected 1 day before the operation, 1, 3, and 7 days after the operation. The time of the first anal exhaust after the operation, the time of the first food intake after the operation, and the occurrence of postoperative adverse reactions such as nausea and vomiting were recorded.
Results: Compared with the control group, the ICFS-10 scores, the incidence of POFS, and the proportion of moderate to severe POFS 1, 3, and 7 days after surgery were significantly decreased in the SGB group (P < 0.05), the total ISI scores 3 and 7 days after surgery were significantly decreased in the SGB group (P < 0.05), the concentrations of plasma 5-HT and MT 1 day after surgery were significantly increased, while the concentrations of IL-6, IL-1β, and TNF-α were significantly decreased in the SGB group (P < 0.05), and the time of the first postoperative anal exhaust and the time of the first postoperative food intake were significantly shortened in the SGB group (P < 0.05). There was no statistically significant difference between the two groups in the VAS pain scores at rest, urine volume, creatinine, urea nitrogen concentration at different time points after the operation, as well as the incidence of postoperative nausea and vomiting, DN4 score, ICFS-10 score, and the incidence of POFS 3 months after the operation.
Conclusion: Ultrasound-guided SGB reduces the incidence and severity of POFS in LKDs, potentially by decreasing inflammatory cytokine release, increasing plasma 5-HT and MT levels, improving postoperative sleep quality, and promoting earlier gastrointestinal recovery.
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