颈部迷走神经阻滞在胃肠手术中预防术中反射性心动过缓的研究进展
Research Progress of Cervical Vagus Nerve Block in the Prevention of Reflex Bradycardia during Gastrointestinal Surgery
DOI: 10.12677/ACM.2024.141127, PDF,   
作者: 杨天宇, 任杨浩, 甄心月, 范冰倩:新疆医科大学第三临床医学院,新疆 乌鲁木齐;王天海*:新疆医科大学附属肿瘤医院麻醉与围术期医学中心,新疆 乌鲁木齐
关键词: 颈部迷走神经阻滞胃肠手术反射性心动过缓Cervical Vagus Block Gastrointestinal Surgery Reflex Bradycardia
摘要: 随着腔镜技术的快速发展,越来越多的胃肠手术得以在更微创的条件下进行。但由于腔镜手术大多在全身麻醉下进行,使得交感神经被抑制,而胃肠手术中的牵拉和CO2气腹又会进一步导致迷走神经兴奋,引起血压降低、心率减慢或心律不齐等,甚至有可能出现休克、心跳骤停等一系列症状。而迷走神经阻滞可以减少术中因手术操作或药物引起的迷走神经兴奋而导致的心动过缓和/或血压下降,且操作简便,安全性高,适用人群较广。所以本文旨在探讨颈部迷走神经阻滞用于预防胃肠手术中由迷走神经介导的心动过缓、血压下降等不良反应的研究进展,为后续相关研究提供参考。
Abstract: With the rapid development of endoscopy technology, more and more gastrointestinal surgery can be performed under less invasive conditions. However, since endoscopic surgery is mostly per-formed under general anesthesia, the sympathetic nerve is suppressed, and the traction and CO2 pneumoperitoneum in gastrointestinal surgery will further lead to vagus nerve excitation, resulting in lower blood pressure, slow heart rate or arrhythmia, and even a series of symptoms such as shock and cardiac arrest. Vagus nerve block can reduce bradycardia and/or blood pressure drop caused by vagus nerve excitation caused by surgery or drugs, and it is simple to operate, high safety, and suitable for a wide range of people. Therefore, this paper aims to discuss the research progress of cervical vagus nerve block in preventing vagus-mediated bradycardia, blood pressure drop and other adverse reactions in gastrointestinal surgery, and provide reference for subsequent relevant studies.
文章引用:杨天宇, 任杨浩, 甄心月, 范冰倩, 王天海. 颈部迷走神经阻滞在胃肠手术中预防术中反射性心动过缓的研究进展[J]. 临床医学进展, 2024, 14(1): 897-902. https://doi.org/10.12677/ACM.2024.141127

参考文献

[1] Smyth, E.C., Nilsson, M., Grabsch, H.I., van Grieken, N.C. and Lordick, F. (2020) Gastric Cancer. The Lancet, 396, 635-648. [Google Scholar] [CrossRef
[2] Antonakis, P.T., Ashrafian, H. and Isla, A.M. (2014) Laparoscopic Gastric Surgery for Cancer: Where Do We Stand? World Journal of Gastroenterology, 20, 14280-14291. [Google Scholar] [CrossRef] [PubMed]
[3] Swan, R. and Miner, T.J. (2006) Current Role of Surgical Therapy in Gastric Cancer. World Journal of Gastroenterology, 12, 372-379. [Google Scholar] [CrossRef] [PubMed]
[4] Facciorusso, A., Antonino, M., Di Maso, M. and Muscatiello, N. (2014) Endoscopic Submucosal Dissection vs Endoscopic Mucosal Resection for Early Gastric Cancer: A Meta-Analysis. World Journal of Gastrointestinal Endoscopy, 6, 555-563. [Google Scholar] [CrossRef] [PubMed]
[5] Kim, D.K., Ahn, H.J., Lee, S.W. and Choi, J.W. (2015) Analysis of Factors Related to Vagally Mediated Reflex Bradycardia during Gastrectomy. Journal of Anesthesia, 29, 874-880. [Google Scholar] [CrossRef] [PubMed]
[6] 刘怀琼, 周定蓉. 手术麻醉中的迷走反射[J]. 中华麻醉学杂志, 2000(11): 62-63.
[7] 邱德刚, 王亚西, 钟倩, 等. 手术中的迷走神经反射[J]. 医学信息(中旬刊), 2011, 24(7): 2989-2990.
[8] 周晋, 林雪梅. 剖宫产术中迷走神经反射致严重心律失常两例[J]. 华西医学, 2021, 36(3): 419-420.
[9] 李新萍. 手术麻醉中的迷走神经-心反射[J]. 基层医学论坛, 2011, 15(17): 557-558.
[10] 王建勇, 赵立炜, 魏庆磊. 肛肠手术致迷走神经兴奋1例[J]. 山东医药, 2008(20): 65.
[11] Bharati, S., Pal, A., Biswas, C. and Biswas, R. (2011) Incidence of Cardiac Arrest Increases with the Indis-criminate Use of Dexmedetomidine: A Case Series and Review of Published Case Reports. Acta Anaesthesiologica Tai-wanica, 49, 165-167. [Google Scholar] [CrossRef] [PubMed]
[12] Hammer, G.B., Drover, D.R., Cao, H., Jack-son, E., Williams, G.D., et al. (2008) The Effects of Dexmedetomidine on Cardiac Electrophysiology in Children. Anes-thesia & Analgesia, 106, 79-83. [Google Scholar] [CrossRef] [PubMed]
[13] 安丽, 高鸿, 段宏伟, 等. 右美托咪定引起心动过缓的心脏电生理机制及其与钾通道的关系[J]. 实用医学杂志, 2015, 31(21): 3496-3498.
[14] 祝瑜, 田磊, 黄燕若, 等. 右美托咪定致家兔窦性心动过缓模型中心脏窦房结Cx45和Cx31.9基因表达的变化[J]. 临床麻醉学杂志, 2017, 33(8): 801-804.
[15] 马彦文, 吴显捷, 姜锋. 右美托咪定对高血压患者全身麻醉拔管期心率收缩压乘积和血压心率比值的影响[J]. 临床和实验医学杂志, 2018, 17(5): 545-547.
[16] Guerrini, G.P., Esposito, G., Magistri, P., Serra, V., Guidetti, C., et al. (2020) Robotic versus Laparoscopic Gastrectomy for Gastric Cancer: The Largest Me-ta-Analysis. International Journal of Surgery, 82, 210-228. [Google Scholar] [CrossRef] [PubMed]
[17] Kiblawi, R., Id-Orcid, X., Zoeller, C., Zanini, A., et al. (2022) Lap-aroscopic versus Open Pediatric Surgery: Three Decades of Comparative Studies. European Journal of Pediatric Surgery, 32, 9-25. [Google Scholar] [CrossRef] [PubMed]
[18] Muaddi, H., Hafid, M.E., Choi, W.J., Lillie, E., de Mestral, C., et al. (2021) Clinical Outcomes of Robotic Surgery Compared to Conventional Surgical Approaches (Laparoscopic or Open): A Systematic Overview of Reviews. Annals of Surgery, 273, 467-473. [Google Scholar] [CrossRef
[19] Liu, F., Huang, C., Xu, Z., Su, X., Zhao, G., et al. (2020) Morbidity and Mortality of Laparoscopic vs Open Total Gastrectomy for Clinical Stage I Gastric Cancer: The CLASS02 Multicenter Randomized Clinical Trial. JAMA Oncology, 6, 1590-1597. [Google Scholar] [CrossRef] [PubMed]
[20] Duepree, H.J., Senagore, A.J., Delaney, C.P., Brady, K.M. and Fazio, V.W. (2002) Advantages of Laparoscopic Resection for Ileocecal Crohn’s Disease. Diseases of the Colon & Rec-tum, 45, 605-610. [Google Scholar] [CrossRef] [PubMed]
[21] Gutt, C.N., Oniu, T., Mehrabi, A., Schemmer, P., Kashfi, A., Kraus, T., et al. (2017) Cardiovascular and Ventilatory Consequences of Laparoscopic Surgery. Circulation, 135, 700-710. [Google Scholar] [CrossRef
[22] Gutt, C.N., Oniu, T., Mehrabi, A., Schemmer, P., Kashfi, A., Kraus, T., et al. (2004) Circulatory and Respiratory Complications of Carbon Dioxide Insufflation. Digestive Surgery, 21, 95-105. [Google Scholar] [CrossRef] [PubMed]
[23] Myles, P.S. (1991) Bradyarrhythmias and Laparos-copy: A Prospective Study of Heart Rate Changes with Laparoscopy. The Australian and New Zealand Journal of Ob-stetrics and Gynaecology, 31, 171-173. [Google Scholar] [CrossRef
[24] Kim, H.J. and Ahn, E. (2022) Risk Factors for Dexme-detomidine-Associated Bradycardia during Spinal Anesthesia: A Retrospective Study. Medicine (Baltimore), 101, e31306. [Google Scholar] [CrossRef
[25] Ivošević, T., Miličić, B., Dimitrijević, M., Ivanović, B., et al. (2018) Risk Factors for Intraoperative Bradycardia during Ear, Nose, Throat and Maxillofacial Surgery. European Ar-chives of Oto-Rhino-Laryngology, 275, 579-586. [Google Scholar] [CrossRef] [PubMed]
[26] Ice, C.J., Personett, H.A., Frazee, E.N., Dierkhising, R.A., Kashyap, R., et al. (2016) Risk Factors for Dexmedetomidine-Associated Hemodynamic Instability in Noncardiac Inten-sive Care Unit Patients. Anesthesia & Analgesia, 122, 462-469. [Google Scholar] [CrossRef
[27] Liu, S., Paul, G.E., Carpenter, R.L., Stephenson, C. and Wu, R. (1995) Prolonged PR Interval Is a Risk Factor for Bradycardia during Spinal Anesthesia. Regional Anesthesia, 20, 41-44.
[28] Armour, R., Learning, C. and Trojanowski, J. (2022) Paradoxical Worsening of Bradycardia Following At-ropine Administration. British Paramedic Journal, 7, 38-42. [Google Scholar] [CrossRef] [PubMed]
[29] Patterson, E., Po, S.S., Scherlag, B.J., Lazzara, R., et al. (2005) Triggered Firing in Pulmonary Veins Initiated by in Vitro Autonomic Nerve. Heart Rhythm, 2, 624-631. [Google Scholar] [CrossRef] [PubMed]
[30] 侯月梅, 阿依古力, Benjamin J. Scherlag. 心脏血管内迷走神经丛刺激与阵发性心房颤动的动物模型制作[J]. 中国心脏起搏与心电生理杂志, 2003, 17(3): 40-43.
[31] 马丽, 黄焰, 张小琴, 等. 自主神经对左上肺静脉电生理特征的影响[J]. 中国心脏起搏与心电生理杂志, 2006, 20(3): 222-224.
[32] 高利娥, 边红喜. 论阿托品的药理作用及临床应用[J]. 中国实用医药, 2009, 4(24): 137-138.
[33] Mirakhur, R.K., Clarke, R.S., Elliott, J. and Dundee, J.W. (1978) Atropine and Glycopyrronium Premed-ication. A Comparison of the Effects on Cardiac Rate and Rhythm during Induction of Anaesthesia. Anaesthesia, 33, 906-912. [Google Scholar] [CrossRef
[34] Dabbous, A.S., Baissari, M.C., Nehme, P.W., Esso, J.J. and Abu Leila, A.M. (2014) Perioperative Reflex Bradycardia and Cardiac Arrest. Middle East Journal of Anesthesiology, 22, 353-360.
[35] 郭海燕, 张国元, 谢文娟, 等. 长托宁与阿托品对围术期内全身麻醉患者生理功能影响的比较[J]. 当代医学, 2022, 28(19): 134-137.
[36] Mackey, D.C., Carpenter, R.L., Thompson, G.E., Brown, D.L. and Bodily, M.N. (1989) Bradycardia and Asystole during Spinal Anesthesia: A Report of Three Cases. Anesthesiology, 70, 866-868. [Google Scholar] [CrossRef] [PubMed]
[37] Varosy, P.D., Chen, L.Y., Miller, A.L., Noseworthy, P.A., Slotwiner, D.J., et al. (2017) Pacing as a Treatment for Reflex-Mediated (Vasovagal, Situational, or Carotid Sinus Hypersensitivity) Syncope: A Systematic Review for the 2017 ACC/AHA/HRS Guideline for the Evaluation and Man-agement of Patients with Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation, 136, e123-e135. [Google Scholar] [CrossRef
[38] Yuan, H. and Silberstein, S.D. (2016) Vagus Nerve and Vagus Nerve Stimulation, a Comprehensive Review: Part I. Headache, 56, 71-78. [Google Scholar] [CrossRef] [PubMed]
[39] Ruffoli, R., Giorgi, F.S., Pizzanelli, C., Murri, L., Paparelli, A. and Fornai, F. (2011) The Chemical Neuroanatomy of Vagus Nerve Stimulation. Journal of Chemical Neuroanatomy, 42, 288-296. [Google Scholar] [CrossRef] [PubMed]
[40] Gong, W.Y., Yue, X.F., Cheng, C., Peng, T. and Fan, K. (2021) The Application of Cervical Vagus Nerve Block in the Awake Video-Assisted Thoracic Surgery for Bullectomy. Anaesthesia Critical Care & Pain Medicine, 40, Article ID: 100823. [Google Scholar] [CrossRef] [PubMed]
[41] Gong, W.Y., Yue, X.F., Cheng, C., Peng, T. and Fan, K. (2020) Combined Cervical Vagus Nerve and Multilevel Thoracic Paravertebral Blocks in the Internal Rib Fixation and Thoraco-scopic Exploration. Minerva Anestesiologica, 86, 1363-1365. [Google Scholar] [CrossRef
[42] Wang, S.Z., Gu, E.H., Zhang, K.K. and Zhao, J. (2010) A Clinical Research about the Effect of Vagus Nerve Block in Cervical Part to Prevent Oculocardiac Reflex. Chinese Jour-nal of Ophthalmology, 46, 1016-1020.
[43] 王淑珍, 顾恩华, 张抗抗, 等. 颈部迷走神经阻滞预防眼心反射的临床研究[J]. 中华眼科杂志, 2010, 46(11): 1016-1020.
[44] 杨忠宇. 颈部迷走神经阻滞对腔镜手术相关术后并发症的影响[D]: [硕士学位论文]. 乌鲁木齐: 新疆医科大学, 2023.