Clinical Research on Early Modulation of Cervical Sympathetic Block in Severe Trauma Patients
|School||Third Military Medical University|
|Course||Health Care Management|
|Keywords||trauma early stage stellate ganglion block (SGB) sympathetic nerve nerve block inflammatory factor|
Human health and lives are threatened by more and more factors causing trauma in modern society. The systemic inflammatory response syndrome (SIRS)in early severe trauma is the important reason for severe complications and deaths. The pathophysiological reaction of neuro-endocrine-immune network is involved in the mechanism of SIRS after trauma, which is the key for pathological development and turnover. It is the primary task for trauma medicine to administer modulation therapy and prevent deaths in early stage and to spare the time for later treatment and tissue repair.The previous study in animal experiments showed that cervical sympathetic block (SB)might modulate the systemic inflammatory response after trauma and prevent the proceeding to multiple organs dysfunetion syndrome (MODS), thus decrease the mortality of burned mice significantly. We supposed the same modulation may happen in human. In this study the severe trauma patients were given stellate ganglion block (SGB) and the effects on vital signs and main inflammatory factors in SIRS in the early stage after severe trauma were observed. The regulatory role and therapy mechanism of SGB in inflammatory reaction after trauma was explored, which suggested a novel therapy for trauma patients.SGB appeared a hundred years ago in clinic and was administered extensively for many kinds of diseases. The usage of SGB hasn’t been reported in severe trauma patients. Our research was separated into two parts: firstly, the short-acting lidocaine was used in trauma patients via SGB. The safety of SGB was assessed observing its effects on respiration and circulation, and the complications. Secondly, the long-acting ropivacaine was used in early stage in severe trauma patients. The effects of SGB on proinflammatory factors IL-1β, IL-6, TNF-αand anti-inflammatory factors IL-4 and IL-10 were observed. The modulation mechanism of SGB on severe trauma in early stage was explored. Research content:1. 60 patients with severe trauma (ISS evaluation ranges from 16 to 25; gender unrequired; range from 20 to 60 years old, healthy and injuried in 12 hours; no indications for emergency surgery; admitted in Southwest Hospital from November, 2008 to October, 2009) were registered. A safety research was carried in 30 patients, who registered from November, 2008 to January, 2009. The modulation effect of SGB on inflammatory factors was explored in 30 patients, who registered from February 2009 to October, 2009. This study was approved by the Ethics Committee of the affiliated Southwest Hospital, the Third Military Medical University. Consent forms were obtained from each patients and/or family. 0.75% lidocaine hydrochloride was administered in right cervical sympathetic block in treatment group under close monitoring while saline in control with the same routine therapy. Respiratory rate (RR), heart rate(HR), systolic blood pressure (SBP), pulse oxygen saturation (SPO2) , partial pressure of oxygen[P(O2)], & carbon dioxide[P(CO2)]and pH value in arterial blood gas analysis, occurrence of complications before SGB, 10 minutes after block and 50 minutes after block were recorded.2. The effect of SGB on relevant cytokines: 30 patients with severe trauma were divided into 2 groups in random: the treatment group(n=15)and control group(n=15). 8 ml ropivacaine (0.75%) was administered in right stellate block in treatment group while saline in control with the same routine therapy. Thrice SGB operations with 12 hours interval were given. The blood samples were obtained before first SGB and 6, 24 and 72 hours after first SGB. The concentrations of IL-1, IL-4,IL-6, IL-10 and TNF-αwere determined by ELISA. The data were analyzed with statistics.Research results:1. The safety of SGB: There was very significant difference (P<0.01) between the heart rates before SGB(115.9±10.5/min) and 10 min after SGB(101.6±3.6/min), and 50 min after SGB (104±4.6/min). It was suggested that heart rates were decreased obviously after SGB in the early stage after trauma. No statistic differences between values of ABG, RR and SBP before and after first SGB were found. No serious complications happened.2. The effects of SGB on relevant inflammatory cytokines after severe trauma: The concentration of IL-1β24h after SGB was significantly lower than the ones in control group(control group 32.2461±13.5704, therapy group 20.7531±6.2622, P<0.01) ; The concentration of IL-6 72h after SGB was significantly lower than the ones in control group(control group 137.7060±89.1867, therapy group 52.3733±56.4255,P<0.01); The concentration of TNF-α72h after SGB was significantly lower than the ones in control group(control group 13.2745±6.6430,therapy group 8.0305±2.1969,P<0.01). It was suggested that SGB restrained the three proinflammatory factors (IL-1β, IL-6, TNF-α) obviously in early severe trauma, and had no obvious influence on antiinflammatory factors (IL-4 and IL-10). No statistic difference was found among the values at different interval after SGB(P>0.05)in group comparision.Conclusion:1. Right SGB plays a great role on the early circulation in severe trauma patient that may slow down increased heart rate, but has no obvious impact on respiration and arterial blood gas (ABG.). It was suggested that it’s safe to administer SGB in severe trauma patients in the early stage.2. SGB restrains the three proinflammatory factors ( IL-1β, IL-6, TNF-α) obviously in early severe trauma, and has no obvious influence on antiinflammatory factors (IL-4 and IL-10).3. SGB is a simple and safe therapy, and a promising method for early remedy in trauma patients, which modulates the early inflammatory reaction efficiently.