右侧星状神经节阻滞联合右美托咪定对腹腔镜全子宫切除术患者术后恢复质量的影响

doi:10.3969/j.issn.2095-378X.2026.03.008

摘要/Abstract

摘要： 目的观察超声引导下右侧星状神经节阻滞（SGB）联合右美托咪定（Dex）对腹腔镜全子宫切除术患者术后恢复质量的影响。方法选择拟行腹腔镜全子宫切除术患者60例,按随机数字表法分为Dex组（D组）及SGB联合Dex（SD组）,每组30例。D组患者麻醉诱导前10 min开始给予Dex持续泵注,直至手术结束;SD组患者麻醉诱导前行右侧SGB,注入0.2％罗哌卡因5 mL,同时麻醉诱导前10 min开始给予Dex持续泵注,直至手术结束。两组患者采用的麻醉方法和技术均相同。观察指标：（1）记录麻醉实施前（T0）、气管插管时（T1）、切皮即刻（T2）及拔管时（T3）的心率（HR）、平均动脉压（MAP）等指标,记录术中麻醉药物的用量及拔除气管插管时间。（2）采用多导睡眠监测（PSG）记录手术当日睡眠潜伏时间（SL）、总睡眠时间（TST）、入睡后清醒时间（WASO）、睡眠效率（SE）、快速眼动睡眠（REM）占比。记录两组患者术前、术后24 h、术后48 h圣玛丽医院睡眠问卷（SMHSQ）评测得分。于手术当日及术后第1天清晨7：00—8：00分别采血测定24 h皮质醇水平。（3）记录术后48 h镇痛补救情况及术后不良反应情况。结果与D相比,SD组患者T1、T2、T3时间点HR、MAP均降低（P<0.05）;SD组术中丙泊酚、瑞芬太尼用量,术后苏醒拔管时间均明显少于D组（P<0.05）。与D相比,SD组患者手术当晚SL、WASO减少（P<0.05）,TST、SE、REM占比增加（P<0.05）。与D组比较,SD组术后24 h及术后48 h的SMHSQ总分均明显降低（P<0.05）,术后24 h皮质醇含量也明显降低（P<0.05）。SD组镇痛补救比例及恶心呕吐、头晕发生率均显著低于D组（P<0.05）。结论右侧星状神经节阻滞联合右美托咪定可有效改善腹腔镜全子宫切除术患者的术后失眠症状,改善睡眠结构及分期,降低术后胃肠道不良反应,加速术后康复。

关键词: 星状神经节阻滞, 右美托咪定, 腹腔镜全子宫切除术, 术后睡眠障碍, 恶心呕吐

Abstract: Objective To observe the effect of ultrasound-guided right stellate ganglion block （SGB） combined with dexmedetomidine （Dex） on postoperative recovery quality of patients undergoing laparoscopic total hysterectomy. Methods Sixty patients scheduled for laparoscopic total hysterectomy were randomly divided into two groups： Dex group （D group） and SGB combined with Dex group （SD group）, with 30 patients in each group. D group patients received continuous Dex infusion commencing 10 min prior to anaesthetic induction and continuing until the end of surgery. SD group patients underwent right SGB prior to anaesthetic induction, receiving 5 mL of 0.2% ropivacaine, concurrently with continuous Dex infusion initiated 10 min before induction and maintained throughout surgery. Identical anaesthetic techniques and protocols were employed for both groups. Observation indexes：（1） We recorded heart rate （HR）, mean arterial pressure （MAP）, and other parameters at pre-anaesthesia （T0）, tracheal intubation （T1）, skin incision （T2）, and extubation （T3）, as well as intraoperative anaesthetic drug consumption and tracheal tube removal time. （2） We used polysomnography （PSG） to record sleep time （SL）, total sleep time （TST）, wake after sleep onset （WASO）, sleep efficiency （SE）, and the proportions of rapid eye movement sleep （REM） on the day of operation; we administered the St Mary’s Hospital Sleep Questionnaire （SMHSQ） for both groups preoperatively, at 24 h postoperatively, and at 48 h postoperatively; we also measured 24 h cortisol levels at 7：00-8：00 am on the day of surgery and on the first day after surgery. （3） We documented analgesic rescue requirements and adverse reactions at 48 h postoperatively. Results Compared with the D group, the SD group exhibited reduced HR and MAP at T1, T2, and T3 time points （P<0.05）. The intraoperative consumption doses of propofol and remifentanil as well as the postoperative awakening and extubation time in the SD group were significantly less than those in the D group （P<0.05）. Compared with the D group, the SD group exhibited reduced SL and WASO on the night of surgery （P<0.05）, but increased TST, SE, and REM proportions （P<0.05）. Compared with the D group, the SD group exhibited significantly lower total SMHSQ scores at 24 and 48 h postoperatively （P<0.05）, and lower cortisol levels （P<0.05） at 24 h postoperatively. The proportion requiring analgesic rescue and incidence of nausea / vomiting, and dizziness were both significantly reduced in the SD group than the D group （P<0.05）. Conclusion Right SGB combined with Dex effectively ameliorates postoperative insomnia symptoms in patients undergoing laparoscopic total hysterectomy, improves sleep structure and staging, reduces postoperative gastrointestinal adverse reactions, and accelerates postoperative recovery.

Key words: Stellate ganglion block, Dexmedetomidine, Laparoscopic total hysterectomy, Sleep disorder after operation, Nausea and vomiting

中图分类号:

R614.4

毛姗姗, 胡蕊, 黄群, 冯秀梅. 右侧星状神经节阻滞联合右美托咪定对腹腔镜全子宫切除术患者术后恢复质量的影响[J]. 外科研究与新技术（中英文）, 2026, 15(3): 236-241.

MAO Shanshan, HU Rui, HUANG Qun, FENG Xiumei. Effect of right stellate ganglion block combined with dexmedetomidine on postoperative recovery quality of patients undergoing laparoscopic total hysterectomy[J]. Surgical Research and New Technique, 2026, 15(3): 236-241.

参考文献

[1] Chung F, Liao P, Yegneswaran B, et al.Postoperative changes in sleep-disordered breathing and sleep architecture in patients with obstructive sleep apnea[J]. Anesthesiology, 2014, 120(2): 287-298.
[2] Luo M, Song B, Zhu J.Sleep disturbances after general anesthesia: current perspectives[J]. Front Neurol, 2020, 8(11): 629.
[3] 邹叔骋,王朝阳,刘博,等.地西泮对胶质瘤术后睡眠障碍患者神经内分泌免疫因子表达水平的影响[J].中国医师杂志,2018,20(11):1692-1694.
[4] Sibley D, Sellers D, Randall I, et al.Evaluating the effect of preoperative interventions on sleep health in the perioperative period:a systematic review[J]. Sleep Res,2024, 33(4):e14124.
[5] 葛晓燕,王峰,王朋,等.星状神经节阻滞对腹腔镜全子宫切除术患者术后睡眠质量和恶心呕吐的影响[J].临床麻醉学杂志,2023,39(3):241-245.
[6] 张常乐,徐帅.低剂量艾司氯胺联合右美托咪定对腹腔镜全子宫切除术后患者疼痛及睡眠的影响[J].中国计划生育学杂志,2025,33(1):66-71.
[7] Moody OA, Zhang ER, Vincent KF, et al.The neural circuits underlying general anesthesia and sleep[J]. Anesth Analg, 2021, 132(5): 1254-1264.
[8] Narayanasamy S, Winograd-Gomez V, Joshi H, et al.Outcomes of dexmedetomidine sedation for drug-induced sleep cine magnetic resonance imaging studies in pediatric obstructive sleep apnea patients[J]. Paediatr Anaesth, 2021, 31(11): 1241-1249.
[9] Bartosiak K, Schwabe M, Lucey B, et al.Sleep disturbances and disorders in patients with knee osteoarthritis and total knee arthroplasty[J]. J Bone Joint Surg Am[J]. 2022,104(21): 1946-1955.
[10] Toleska M, Dimitrovski A, Dimitrovska NT.Postoperative nausea and vomiting in opioid-free anesthesia versus opioid based anesthesia in laparoscopic cholecystectomy[J]. Pril (Makedon Akad Nauk Umet Odd Med Nauki), 2022, 43(3): 101-108.
[11] Zhou L, Yu K, Yang L, et al.Sleep duration, midday napping, and sleep quality and incident stroke: the dongfeng-tongji cohort[J]. Neurology, 2020, 94(4): e345-e356.
[12] Toyoshima M, Noguchi Y Otsubo M, et a1. Differences in detected safety signals between benzodiazepines and non-benzodiazepine hypnotics: pharmacovigilance study using a spontaneous reporting system[J]. Int J Med Sci, 2021, 18(5): 1130-1136.
[13] Huang X, Lin D, Sun Y, et al.Effect of dexmedetomidine on postoperative sleep quality: a systematic review[J]. Drug Des Devel Ther, 2021, 21(15): 2161-2170.
[14] Duan G, Wang K, Peng T, et al.The effects of intraoperative dexmedetomidine use and its different dose on postoperative sleep disturbance in patients who have undergone non-cardiac major surgery: a real-world cohort study[J]. Nat Sci Sleep, 2020 12(12): 209-219.
[15] Lu H, He F, Huang Y, et al.Different doses of dexmedetomidine reduce postoperative sleep disturbance incidence in patients under general anesthesia by elevating serum neurotransmitter levels[J]. Crit Rev Immunol, 2024, 44(6): 63-73.
[16] Guo B, Chen C, Yang L, et al.Effects of dexmedetomidine on postoperative cognitive function of sleep deprivation rats based on changes in inflammatory response[J]. Bioengineered, 2021, 12(1): 7920-7928.
[17] Li Z, Wang W, Sun Q, et al.Postconditioning of stellate ganglion block improves intestinal barrier function by inhibiting autophagy in conscious rats following hemorrhagic shock and resuscitation[J]. Chin Med J (Engl), 2022, 135(8): 1003-1005.
[18] 程章仁. 超声引导下右侧星状神经节阻滞对腹腔镜下全子宫切除患者术后睡眠质量的影响[D].福州:福建医科大学,2022.
[19] Yang RZ, Li YZ, Liang M.et al.Stellate ganglion block improves postoperative sleep quality and analgesia in patients with breast cancer: a randomized controlled trial[J]. Pain Ther, 2023, 12(2): 491-503.
[20] 古翠方,翟明见,吕爱俊,等.超声引导下的星状神经节阻滞可改善老年肺癌患者胸腔镜术后早期睡眠:86例前瞻性随机对照试验[J].南方医科大学学报,2022,42(12):1807-1814.
[21] Wu CN, Wu XH, Yu DN, et al.A single-dose of stellate ganglion block for the prevention of postoperative dysrhythmias in patients undergoing thoracoscopic surgery for cancer: a randomised controlled double-blind trial[J]. Eur J Anaesthesiol,2020, 37(4): 323-331.
[22] 黄金凤,黄梦雨,陆礼柏,刘俊福.右美托咪定对行肝叶切除术的老年患者睡眠质量、炎症因子和谵妄发生率的影响[J].老年医学与保健,2025,31(2):515-518.