超声引导下星状神经节阻滞治疗失眠的研究进展

Research Progress of Ultrasound-Guided Stellate Ganglion Block for Insomnia

摘要: 目的：综述超声引导下星状神经节阻滞(stellate ganglion block, SGB)治疗失眠的研究进展，为临床规范化应用和后续研究提供参考。方法：围绕失眠高觉醒机制、星状神经节解剖基础、超声引导技术、可能作用机制、临床研究证据及安全性等方面，对近年相关英文文献进行归纳分析。结果：现有研究提示，SGB可能通过调节交感–副交感平衡、影响下丘脑–垂体–肾上腺轴、改善应激反应、调节睡眠相关神经递质及缓解疼痛或情绪症状，从而改善部分失眠患者的睡眠质量。超声引导有助于实时显示颈部重要血管、神经及筋膜间隙，提高穿刺精准性并降低并发症风险。结论：超声引导下SGB在慢性失眠、焦虑相关睡眠障碍、围术期睡眠障碍及夜间觉醒相关症状中具有一定应用前景，但目前证据仍存在样本量小、异质性大、随访不足和操作方案不统一等局限，尚不宜替代认知行为治疗失眠等一线疗法。

Abstract: Objective: To review the research progress of ultrasound-guided stellate ganglion block (SGB) in the treatment of insomnia, so as to provide references for standardized clinical application and further research. Methods: Recent relevant English literatures were summarized and analyzed focusing on the hyperarousal mechanism of insomnia, anatomical basis of the stellate ganglion, ultrasound guidance technique, potential mechanisms of action, clinical research evidence and safety profile. Results: Existing studies suggest that SGB may improve sleep quality in some patients with insomnia by regulating sympathetic-parasympathetic balance, modulating the hypothalamic-pituitary-adrenal axis, alleviating stress responses, adjusting sleep-related neurotransmitters, and relieving pain or emotional symptoms. Ultrasound guidance enables real-time visualization of vital cervical blood vessels, nerves and fascial spaces, which improves puncture accuracy and reduces the risk of complications. Conclusion: Ultrasound-guided SGB shows promising prospects for the management of chronic insomnia, anxiety-related sleep disorders, perioperative sleep disorders and nocturnal arousal-related symptoms. However, current evidence is limited by small sample sizes, high heterogeneity, insufficient follow-up and inconsistent operational protocols. Therefore, SGB cannot yet replace first-line therapies such as cognitive behavioral therapy for insomnia.