星状神经节阻滞联合艾司氯胺酮对烧伤患者 术后早期情绪状态的疗效评估

Efficacy Evaluation of Stellate Ganglion Block Combined with Esketamine on the Early Postoperative Emotional State of Burn Patients

摘要: 目的：探讨星状神经节阻滞(Stellate Ganglion Block, SGB)联合艾司氯胺酮对烧伤患者术后早期情绪状态的疗效。方法：共纳入医院收治的90例行烧伤削痂植皮术患者。随机分为SGB联合艾司氯胺酮组(L组)、艾司氯胺酮组(A组)和对照组(D组)，每组30例。L组诱导前予0.2%罗哌卡因4 ml行右侧SGB，L组和A组予艾司氯胺酮诱导及维持，D组均予等量盐水替代。比较三组患者不同时间点血流动力学指标、炎症因子水平、应激因子水平、HADS评分、VAS评分及不良反应。结果：组内比较，L组和A组术后24 h、48 h的HADS评分均低于术前(P < 0.05)。组间比较，L组在T1、T2、T3、T5时点的HR，T5的MAP均低于A组及D组(P < 0.05)；L组术后24 h、48 h的HADS评分均低于A组及D组(P < 0.05)；L组拔管后30 min、术后12 h的VAS评分均低于A组及D组(P < 0.05)；L组术后白介素-6 (IL-6)、C反应蛋白(CRP)、皮质醇(Cor)均低于A组及D组(P < 0.05)。结论：SGB联合艾司氯胺酮可以改善烧伤患者术后早期抑郁情绪、稳定术中血流动力学、缓解术后短期疼痛、减轻术后炎症及应激反应。

Abstract: Objective: To explore the efficacy of stellate ganglion block (SGB) combined with esketamine on the early postoperative emotional state of burn patients. Methods: A total of 90 burn patients undergoing escharectomy and skin grafting in the hospital were included. They were randomly divided into the SGB combined with esketamine group (Group L), the esketamine group (Group A), and the control group (Group D), with 30 cases in each group. Group L received 4 ml of 0.2% ropivacaine for right-sided SGB before induction. Both Group L and Group A were induced and maintained with esketamine, while Group D was given an equal volume of normal saline instead. The hemodynamic parameters, levels of inflammatory factors, levels of stress factors, Hospital Anxiety and Depression Scale (HADS) scores, Visual Analogue Scale (VAS) scores, and adverse reactions of the three groups of patients at different time points were compared. Results: In the within-group comparison, the HADS scores of Group L and Group A at 24 h and 48 h after surgery were lower than those before surgery (P < 0.05). In the between-group comparison, the heart rate (HR) of Group L at time points T1, T2, T3, and T5, and the mean arterial pressure (MAP) at T5 were lower than those of Group A and Group D (P < 0.05); the HADS scores of Group L at 24 h and 48 h after surgery were lower than those of Group A and Group D (P < 0.05); the VAS scores of Group L at 30 min after extubation and 12 h after surgery were lower than those of Group A and Group D (P < 0.05); the levels of interleukin-6 (IL-6), C-reactive protein (CRP), and cortisol (Cor) in Group L after surgery were lower than those in Group A and Group D (P < 0.05). Conclusion: SGB combined with esketamine can improve the early postoperative depressive mood, stabilize intraoperative hemodynamics, relieve short-term postoperative pain, and reduce postoperative inflammation and stress response in burn patients.