顺式阿曲库铵和喉上神经阻滞在经鼻盲探插管中的应用  

Subclinical-dosage cisatracurium and superior laryngeal nerve block facilitate blind nasotracheal intubation

作　　者：于冬男[1] 朱毅[1] 于卫[1] 王越洪[1] 马珏[1] 

机构地区：[1]广东省人民医院广东省医学科学院麻醉科,广东广州510080

出　　处：《热带医学杂志》2015年第6期780-782,835,共4页Journal of Tropical Medicine

摘　　要：目的探讨亚临床剂量顺式阿曲库铵和喉上神经阻滞技术在经鼻盲探气管插管中的价值。方法 50例寰椎或枢椎损伤准备在经鼻插管全麻下行经口寰枢椎内固定术患者,随机分为3组:A组,顺式阿曲库铵组(n=17),麻醉诱导后静注顺式阿曲库铵0.025 mg/kg;B组,喉上神经阻滞组(n=17),在诱导前5 min行右侧喉上神经阻滞;C组,对照组(n=16)。在诱导前(T1)、气管插管即刻(T2)、插管后1 min(T3)分别记录各组平均动脉压(MAP)、心率(HR)、血氧饱和度(SPO2)、呼气末二氧化碳分压(ETCO2)以及插管时间和次数,计算插管成功率。结果 A、B两组的插管次数[(1.82±0.81)、(1.88±0.86)vs(2.50±0.63),P=0.016,0.027]和插管时间[(163.94±68.63)s、(169.29±46.46))s vs(224.63±65.95)s,P=0.006,0.012]较C组差异有统计意义。A、B组插管成功率分别为88.2%、82.4%,均高于C组的68.8%(P=0.006,P=0.023)。A组SPO2[(91.94±3.34)%]在T2时较B组[(96.53±2.45)%]和C组[(96.25±2.25)%]低,差异有统计学意义(P<0.001)。在T3时,A组ETCO2高于B组和C组[(45.76±4.51)mm Hg vs(36.88±2.14)mm Hg、(36.18±1.87)mm Hg],差异有统计学意义(P<0.001)。结论亚临床剂量的顺式阿曲库铵和单侧喉上神经阻滞能提高插管成功率、减少插管时间,但亚剂量顺式阿曲库铵在保留自主呼吸的经鼻插管中会引起轻微的呼吸抑制。Objective To evaluate the clinical value of subclinical-dosage cisatracurium intravenous injection and unilateral superior laryngeal nerve block during blind nasotracheal intubation. Methods Total 50 patients with atlantoaxial dislocation or fracture scheduled to frontal atlanto-axial fixation through mouth were selected and randomly divided into 3 groups. They all underwent blind nasotracheal intubation with general anesthesia. group A（n =17）, patients were given cisatracurium by 0.025 mg / kg intravenously soon after induction of anesthesia; right superior laryngeal nerve block were given to the patients in group B（n =17） 5 minutes preceding to anesthesia induction; group C（n =16） was control group which completed blind nasotracheal intubation under normal anesthesia induction with spontaneous breath. Mean arterial pressure（MAP）,heart rate（HR）,oxygen saturation（SPO2）, and end-tidal carbon dioxide partial pressure（ETCO2）were record by another anesthetist according to scheduled time points ： T1, preceding induction; T2, just intubation; T3,1minute after intubation. Total time required for intubation and intubation numbers were also recorded, then the successful rates were calculated. Results The average intubation times of group A and group B vs control group were（1.82±0.81）and（1.88 ±0.86） vs（2.50 ±0.63）（P =0.016, 0.027） and duration were（163.94 ±68.63）s and（169.29 ±46.46）s vs（224.63±65.95）s（P=0.006,0.012）, similar between Group A and Group B but much lower than that in Group C. SPO2 in patients from Group A was much lower than that in Group B and Group C [（91.94±3.34）% vs（96.53±2.45）%,（96.25 ±2.25）%, P〈0.001] at T2. However, ETCO21 minute after intubation was significant higher in Group A compared to Group B or C [（45.76 ±4.51）mm Hg vs（36.88 ±2.14）mm Hg,（36.18 ±1.87）mm Hg, P〈0.001]. Conclusions Subclinical-dosage cisatracurium intravenous injection following anesthesia induction and superior laryngeal nervous bl

关 键 词：经鼻盲探 气管插管 喉上神经阻滞 顺式阿曲库铵 

分 类 号：R768.1[医药卫生—耳鼻咽喉科]