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目的 探讨超声引导下星状神经节阻滞在动脉瘤脑出血患者中的临床应用价值.方法 选择2017年1 1月至2019年3月浙江省医疗健康集团杭州医院动脉瘤所致蛛网膜下隙出血患者80例,按照随机数字表法分为观察组和对照组,每组40例.两组患者均行开颅血肿清除术,术毕对照组给予尼莫地平,观察组则在对照组的基础上,行超声引导下右侧星状神经节阻滞.两组分别于术前、术后6h和术后24 h采用经颅多普勒超声检测大脑中动脉血流速度,反映脑血管痉挛情况;术后24 h抽取桡动脉和颈内静脉球部血标本检测和计算脑氧代谢指标,包括颈内静脉球部血氧饱和度、动-静脉血氧含量差和脑氧摄取率;术后24 h抽取肘静脉血检测IgG、IgA和IgM;术后随访1周,观察并发症发生情况.结果 两组术前大脑中动脉血流速度比较差异无统计学意义(P＞0.05);观察组术后6和24h大脑中动脉血流速度均明显低于对照组[(100.8±8.2) cm/s比(123.5±9.9) cm/s和(89.7±5.3) cm/s比(118.9±7.1) cm/s],差异有统计学意义(P＜0.01).观察组术后24h颈内静脉球部血氧饱和度、脑氧摄取率、IgG、IgA和IgM明显高于对照组[0.704±0.035比0.598±0.058、(57.5±6.5)％比(49.7±3.6)％、(12.5±0.3) mg/L比(5.0±0.1) mg/L、(5.5±0.3) mg/L比(2.1±0.1) mg/L和(4.3±0.3) mg/L比(1.9±0.2) mg/L],动-静脉血氧含量差和总并发症发生率明显低于对照组[(40.8±3.2) ml/L比(58.3±8.6) ml/L和5.0％(2/40)比25.0％(10/40)],差异有统计学意义(P＜0.01或＜0.05).结论 动脉瘤脑出血患者行超声引导下星状神经节阻滞治疗,能有效改善脑血流,确保脑氧供,提高机体免疫能力,减少术后并发症发生率,提高临床治疗效果.“,”Objective To explore the application value of ultrasound-guided stellate ganglion block in patients with aneurysmal cerebral hemorrhage.Methods Eighty patients with subarachnoid hemorrhage caused by aneurysm from November 2017 to March 2019 in Hangzhou Hospital of Zhejiang Medical Health Group were selected.The patients were divided into observation group and control group by random digits table method with 40 cases in each group.All patients were treated with craniotomy hematoma removal.At the conclusion of the surgical procedure,the control group was treated with nimodipine,while the observation group was treated with ultrasound-guided right stellate ganglion block on the basis of nimodipine.The blood flow velocity of middle cerebral artery before operation and 6,24 h after operation by transcranial Doppler sonography were detected to reflect cerebral vasospasm status;the blood samples from the radial artery and internal jugular bulb 24 h after operation were used to detect and count cerebral oxygen metabolism indexes,including the blood oxygen saturation of internal jugular bulb,arteriovenous oxygen content difference and cerebral oxygen uptake rate;the IgG,IgA and IgM 24 h after operation were detected.The patients were followed up at 1 week after operation,and the complication was observed.Results There was no statistical difference in the blood flow velocity of middle cerebral artery before operation between 2 groups (P＞0.05);the blood flow velocity of middle cerebral artery 6 and 24 h after operation in observation group was significantly lower than that in control group:(100.8± 8.2) cm/s vs.(123.5 ± 9.9) cm/s and (89.7 ± 5.3) cm/s vs.(118.9 ± 7.1) cm/s,and there was statistical difference (P＜0.01).The blood oxygen saturation of internal jugular bulb,cerebral oxygen uptake rate,IgG,IgA and IgM 24 h after operation in observation group were significantly higher than those in control group:0.704 ± 0.035 vs.0.598 ± 0.058,(57.5 ± 6.5)％ vs.(49.7 ± 3.6)％,(12.5 ± 0.3) mg/L vs.(5.0 ± 0.1) mg/L,(5.5 ± 0.3) mg/L vs.(2.1 ± 0.1) mg/L and (4.3 ± 0.3) mg/L vs.(1.9 ± 0.2) rg/L,the arteriovenous oxygen content difference and incidence of complication were significantly lower than those in control group:(40.8 ± 3.2) ml/L vs.(58.3 ± 8.6) ml/L and 5.0％ (2/40) vs.25.0％ (10/40),and there were statistical differences (P＜0.01 or ＜0.05).Conclusions For patients with aneurysmal intracerebral hemorrhage,ultrasound-guided stellate ganglion block therapy can effectively improve cerebral blood flow,ensure cerebral oxygen supply,improve humoral immunity,reduce the incidence of postoperative complication,and achieve the purpose of improving clinical therapeutic effect.