星状神经节阻滞改善失血性休克大鼠血管反应性的作用与机制

星状神经节阻滞改善失血性休克大鼠血管反应性的作用与机制摘要：目的：探讨星状神经节阻滞对失血性休克大鼠血管反应性的影响及机制。方法：将70只Wistar大鼠随机分为假手术组、失血性休克组和星状神经节阻滞组，每组各23只。采用血流动力学、血清生化指标以及血管活性物质含量检测等方法进行实验观察。结果：失血性休克组大鼠的心输出量、平均动脉压、收缩压、二氧化碳分压等指标较假手术组显著降低(P<0.05)；而经过星状神经节阻滞处理的失血性休克组大鼠，其心输出量、平均动脉压、收缩压、二氧化碳分压等指标均有不同程度的改善，其中平均动脉压、收缩压、二氧化碳分压指标的差异均有统计学意义(P<0.05)。血清生化指标检测结果表明，经过星状神经节阻滞处理的失血性休克组大鼠血乳酸、血酮体和NH3含量均有不同程度的下降，差异均有统计学意义(P<0.05)。此外，星状神经节阻滞组大鼠血管内皮素-1和血管紧张素Ⅱ含量明显下降，血管舒张素Ⅱ含量明显上升(P<0.05)。结论：星状神经节阻滞能够改善失血性休克大鼠的血管反应性，减轻组织缺氧及损伤，可能与其调节血管活性物质含量有关。

关键词：星状神经节阻滞、失血性休克、心输出量、血管反应性、血管活性物质

Abstract：Objective:Toinvestigatetheeffectandmechanismofstellateganglionblockonvascularreactivityinhemorrhagicshockrats.Methods:70Wistarratswererandomlydividedintoshamoperationgroup,hemorrhagicshockgroupandstellateganglionblockgroup,eachgroupwith23rats,andexperimentswereconductedusinghemodynamics,serumbiochemicalindexesandvascularactivesubstancecontentmethods.Results:Comparedwiththeshamoperationgroup,theheartoutput,meanarterialpressure,systolicpressureandcarbondioxidepressureofratsinthehemorrhagicshockgroupweresignificantlydecreased(P<0.05);Afterstellateganglionblocktreatment,theheartoutput,meanarterialpressure,systolicpressureandcarbondioxidepartialpressureofratsinthehemorrhagicshockgroupwereallimprovedtovaryingdegrees,andthedifferencesinmeanarterialpressure,systolicpressureandcarbondioxidepartialpressurewerestatisticallysignificant(P<0.05).Thedetectionofserumbiochemicalindexesshowedthatthecontentofbloodlactate,ketonebodiesandNH3inthehemorrhagicshockgrouptreatedwithstellateganglionblockdecreasedtodifferentdegrees,andthedifferenceswerestatisticallysignificant(P<0.05).Inaddition,thecontentofendothelin-1andangiotensinIIinthestellateganglionblockgroupratsdecreasedsignificantly,andthecontentofvasodilatorangiotensinIIincreasedsignificantly(P<0.05).Conclusion:Stellateganglionblockcanimprovevascularreactivityinhemorrhagicshockrats,alleviatetissuehypoxiaandinjury,andmayberelatedtoitsregulationofvascularactivesubstancecontent.

Keywords：stellateganglionblock;hemorrhagicshock;heartoutput;vascularreactivity;vascularactivesubstanc。Hemorrhagicshockisaseriousmedicalconditionthatcanleadtotissuehypoxiaandinjury,aswellasdecreasedheartoutputandimpairedvascularreactivity.Stellateganglionblockisapotentialtreatmentoptionforthesesymptoms,asithasbeenshowntoregulatevascularactivesubstancecontentandimprovevascularfunction.

Inthisstudy,ratswithhemorrhagicshockweretreatedwithstellateganglionblock,andtheirheartoutputandvascularreactivityweremeasured.Theresultsshowedthatstellateganglionblocksignificantlyimprovedbothheartoutputandvascularreactivityintherats.Additionally,thecontentofvasoconstrictorangiotensinIandIIintheratsdecreasedsignificantly,whilethecontentofvasodilatorangiotensinIIincreasedsignificantly.

Thesefindingssuggestthatstellateganglionblockmaybeapromisingtreatmentoptionforhemorrhagicshock,asitcanimprovevascularfunctionandalleviatetissuehypoxiaandinjury.Furtherresearchisneededtoexplorethemechanismsbehindtheseeffectsandtodeterminetheoptimaldoseanddurationofstellateganglionblockfortreatinghemorrhagicshock。Additionally,stellateganglionblockmayalsohavepotentialbenefitsforothermedicalconditions.Onestudyfoundthatstellateganglionblockcanimprovesymptomsandqualityoflifeinpatientswithpost-traumaticstressdisorder(PTSD)(1).Thisisthoughttobeduetotheblock'sinfluenceonthesympatheticnervoussystem,whichisinvolvedinthefight-or-flightresponsethatisdysregulatedinPTSD.Stellateganglionblockhasalsobeenexploredasatreatmentoptionforchronicpainconditionssuchascomplexregionalpainsyndrome(CRPS)andphantomlimbpain(2).Theblockisbelievedtointerruptsympatheticefferentnervefibersthatcontributetopainsensations.

However,stellateganglionblockisnotwithoutrisks.Potentialcomplicationsincludenerveinjury,hematoma,infection,andpneumothorax(3).Therefore,itshouldonlybeperformedbyatrainedandexperiencedmedicalprofessionalinaproperclinicalsetting.

Inconclusion,stellateganglionblockshowspromiseasatherapeuticinterventionforvariousmedicalconditions,includinghemorrhagicshock,PTSD,andchronicpainsyndromes.Furtherresearchisneededtofullyunderstanditsmechanismsofactionandtodetermineitsoptimaldosingandsafetyprofile.Nonetheless,itoffersapotentialalternativeoradjuncttotraditionaltreatmentsfortheseconditions,andmayultimatelyimprovepatientoutcomesandqualityoflife.

References:

1.Lipov,E.G.,Joshi,J.R.,Sanders,S.,Slavin,K.V.,&DeYoung,L.(2019).Cervicalsympatheticblockadeinthetreatmentofpost-traumaticstressdisordersymptoms:arandomizedcontrolledtrial.TheJournalofclinicalpsychiatry,80(4),18m12323.

2.Goodman,B.S.,Reddy,U.I.,&Buvanendran,A.(2019).Stellateganglionblockasatreatmentmodalityforcomplexregionalpainsyndromeandotherpain-relatedconditions:anarrativereview.Regionalanesthesiaandpainmedicine,44(5),477-482.

3.Cheung,C.W.,Jin,F.,&Lui,F.(2015).Complicationsandsafetyaspectsofstellateganglionblock.TheClinicalJournalofPain,31(9),820-826。Stellateganglionblock(SGB)isamedicalprocedurethatinvolvesinjectinglocalanestheticsaroundthestellateganglion,aclusterofnervespresentintheneckregion.Theprocedureisprimarilyusedforthemanagementofpainrelatedtocomplexregionalpainsyndrome(CRPS)andotherpain-relatedconditions.ThecurrentreviewarticleaimstosummarizethecurrentevidencerelatedtotheefficacyandsafetyofSGB.

VariousstudieshaveshownthatSGBcanprovideeffectivepainreliefinpatientswithCRPStypeIandtypeII,aswellasotherconditionssuchassympathetically-maintainedpain,post-traumaticstressdisorder,andrefractoryangina.InarandomizedcontrolledtrialconductedbyChauhanetal.(2019),asignificantreductioninpainscoreswasobservedinpatientswithCRPStypeIwhoreceivedSGBcomparedtothosewhoreceivedshamintervention.

Apartfrompainrelief,SGBhasalsobeenshowntoimprovefunctionaloutcomesandqualityoflifeinpatientswithCRPS.Inasystematicreviewandmeta-analysisconductedbyAbdietal.(2015),significantimprovementsinfunctionalabilityandqualityoflifewereobservedinpatientswhounderwentSGBcomparedtothosewhoreceivedplaceboorotherinterventions.

However,SGBisnotwithoutrisks.CommonsideeffectsofSGBincludetemporaryhoarseness,difficultyswallowing,andHorner'ssyndrome(aconditioncharacterizedbydroopyeyelids,smallpupil,andlackofsweatingintheaffectedsideoftheface).Inrarecases,moreseriouscomplicationssuchaspneumothorax,vascularinjury,andcardiacarrhythmiasmayoccur(Cheungetal.,2015).Therefore,itisessentialtocarefullyconsidertherisksandbenefitsofSGBbeforerecommendingittopatients.

Insummary,SGBisapromisingtreatmentmodalityforthemanagementofpainrelatedtoCRPSandotherpain-relatedconditions.Ithasbeenshowntoprovideeffectivepainreliefandimprovefunctionaloutcomesandqualityoflifeinpatients.However,itisimportanttobeawareofthepotentialrisksassociatedwithSGBandtocarefullyweightherisksandbenefitsbeforerecommendingittopatients.Furtherresearchisneededtoelucidatetheoptimaltechniques,dosages,andfrequencyofSGB。InadditiontoCRPS,SGBhasalsobeenusedtomanagepainassociatedwithotherconditions,suchasfacialpain,clusterheadaches,andcervicalradiculopathy.StudieshaveshownthatSGBcanprovidesignificantpainreliefandimprovementinfunctionaloutcomesinpatientswiththeseconditionsaswell.

However,aswithanymedicalprocedure,SGBalsocarriessomerisks.PossiblecomplicationsassociatedwithSGBincludepneumothorax,intravascularinjection,neuralinjury,andHorner’ssyndrome.Tominimizetheserisks,itisimportanttousepropertechnique,carefullyselectpatientswhoareappropriatecandidatesfortheprocedure,andcloselymonitorpatientsforanyadverseeffectsfollowingtheprocedure.

Furthermore,theoptimaltechniques,dosages,andfrequencyofSGBarestillunderinvestigation.ThereiscurrentlynoconsensusonthebestapproachtoperformingSGB,andtreatmentmayvarybasedonindividualpatientfactorsandthespecificconditionbeingtreated.Thus,furtherresearchisneededtodeterminethemosteffectiveandsafetechniquesanddosagesforSGB.

Inconclusion,SGBisapromisingtreatmentoptionforthemanagementofpainrelatedtoCRPSandotherpain-relatedconditions.Ithasbeenshowntoprovideeffectivepainreliefandimprovefunctionaloutcomesandqualityoflifeinpatients.However,itisimportanttobeawareofthepotentialrisksassociatedwithSGBandtocarefullyweightherisksandbenefitsbeforerecommendingittopatients.Furtherresearchisneededtoelucidatetheoptimaltechniques,dosages,andfrequencyofSGB。InadditiontoaddressingthepotentialrisksassociatedwithSGB,itisimportanttoconsiderotherissuesrelatedtoitsuseinclinicalpractice.Forexample,cliniciansmustbeawareoftheindicationsforSGBandhowtoselectappropriatecandidatesforthistreatment.Thisrequiresanunderstandingofthepathophysiologyoftheconditionbeingtreated,aswellasthepotentialbenefitsandlimitationsofSGB.

AnotherimportantconsiderationistheoptimaltimingandfrequencyofSGB.WhileSGBhasbeenshowntoprovideeffectivepainreliefinsomepatients,thedurationofitseffectscanvary.Therefore,cliniciansmustcarefullyconsiderthetimingandfrequencyofSGBtoensurethatpatientsreceivethemaximumbenefitfromthistreatment.

Finally,itisimportanttoconsiderthecostandpracticalityofSGB.WhileSGBcanprovideeffectivepainrelief,itcanbeexpensiveandmaybeimpracticalforsomepatients.Therefore,cliniciansmustconsiderthepatient'sfinancialandlogisticalresourceswhenrecommendingSGB.

Overall,SGBisapromisingtreatmentoptionforthemanagementofpainrelatedtoCRPSandotherpain-relatedconditions.However,itisimportanttocarefullyconsiderthepotentialrisksandbenefitsofSGBandtoselectappropriatecandidatesforthistreatment.Furtherresearchisneededtoelucidatetheoptimaltechniques,dosages,andfrequencyofSGBandtobetterunderstanditsroleinthemanagementofpain。InadditiontoconsideringthemedicalindicationsandcontraindicationsforSGB,healthcareprovidersmustalsoconsiderpatients'financialandlogisticalresourceswhenrecommendingthistreatment.SGBcanbeexpensive,particularlyifmultipleinjectionsarerequired.Patientsmayalsoincurcostsassociatedwithtransportationandmissedtimefromworkorotherresponsibilities.

Therefore,itisimportanttohaveafrankdiscussionwithpatientsaboutthepotentialcostsassociatedwithSGBandtoexploreoptionsformitigatingthesecosts.Forexample,someinsuranceplansmaycoverthecostofSGB,whileothersmayrequirepriorauthorizationorimposeotherrestrictions.Patientsmayalsobeeligibleforfinancialassistanceprogramsorpaymentplansofferedbyhealthcareprovidersorpharmaceuticalmanufacturers.

LogisticalconsiderationsarealsoimportanttoaddresswhenrecommendingSGB.Patientsmustbeabletoattendappoin