超声引导下喉上神经内支阻滞联合环甲膜穿刺在纤支镜引导插管中的应用  

Application of internal branch of superior laryngeal nerve block under the guidance of ultrasound combined with cricothyroid membrane puncture in the fiberoptic bronchoscope-guided intubation

作　　者：曹婧[1] 姚益冰 李振平[1] 袁孝忠[1] 周煦燕[1] 

机构地区：[1]嘉兴市第一医院麻醉科,浙江嘉兴314001

出　　处：《全科医学临床与教育》2017年第2期136-139,143,共5页Clinical Education of General Practice

基　　金：浙江省浙北区域麻醉专病中心基金;浙江省医药卫生科技计划一般项目(2015KYA217)

摘　　要：目的探讨超声引导下喉上神经内支(i SLN)阻滞联合环甲膜穿刺用于纤维支气管镜(FOB)引导经鼻清醒插管中的应用效果。方法选取60例拟经鼻气管插管全身麻醉手术的患者,分为传统组和超声组,每组30例。传统组按解剖定位法行i SLN阻滞和环甲膜穿刺,超声组行超声引导下i SLN阻滞和环甲膜穿刺,记录两组患者入室后5 min(T0),气管导管进咽喉(T1),FOB通过声门(T2),气管导管进入气管(T3)各时点的平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(Sp O2)以及在气管插管过程中呛咳、恶心、躁动的例数;记录术后第1天患者对局部麻醉方法评价结果。结果传统组T1、T2、T3的MAP、HR均大于T0(t分别=6.25、7.04、4.20;2.46、2.23、4.12,P均<0.05),Sp O2在T1、T2、T3时较T0时下降(t分别=3.70、5.57、2.73,P均<0.05)。而超声组T1、T2、T3的HR、Sp O2与T0比较,差异无统计学意义(t分别=1.88、1.29、1.91;1.14、0.43、1.00,P均>0.05),T2、T3的MAP与T0比较,差异无统计学意义(t分别=0.27、0.96,P均>0.05)。传统组T1、T2、T3时的MAP、HR比超声组高(t分别=2.99、9.06、2.21;2.60、2.50、3.04,P均<0.05),Sp O2比超声组低(t分别=4.74、3.02、3.01,P均<0.05)。超声组呛咳、恶心、躁动发生率明显低于传统组(χ~2分别=4.71、4.32、4.63,P均<0.05)。超声组患者对局部麻醉方法优良率比例明显高于传统组(χ~2=4.71,P<0.05)。结论超声引导下i SLN阻滞联合环甲膜穿刺用于FOB引导经鼻清醒插管比传统盲探法更能提高阻滞效果,减少并发症的产生。Objective To investigate the effect of internal branch of superior laryngeal nerve （iSLN） block under the guidance of ultrasound combined with cricothyroid membrane puncture applied in the fiberoptic bronchoscope-guided intubation. Methods Sixty patients undergoing general anesthesia under nasotracheal intubation were selected and divided into the traditional group and ultrasound group with 30 cases in each. The traditional group was received iSLN block guided by anatomical position and cricothyroid membrane puncturion,the ultrasound group was received iSLN block guided by ultrasound and cricothyroid membrane puncturion. The mean arterial pressure（MAP）,heat rate （HR） and changes of pulse oxygen saturation （SpO2） at the time of the basal （To）,the moment of intubation （%）, FOB through vocal cords （T2） and endotracheal tube that threaded onto tracheal （T3） were observed as well as the number of coughing,nausea,restlessness in the course of tracheal intubation. The evaluations of topical anesthesia were compared in the first postoperative day.Results Compared with To, the MAP and HR were significantly increased at %,T2 and T3 in the traditional group （t=6.25,7.04,4.20;2.46,2.23,4.12,P〈O.O5）;compared with To, the SpO2 was significantly lower at T1,T2 and T3 （t=3.70,5.57,2.73,P〈O.O5）.The HR and SpO2 at T0, T1,T/ and T3 in the ultrasound group was not statistically different （t= 1.88,1.29,1.91;1.14,0.43,1.00,P 〉0.05）;the MAP at To, T2 and T3 was not statistically different（t=0.27,0.96, P〉0.05）. The MAP and HR in the traditional group were significantly higher than those of ultrasound group at T1,T2 and T3 （t=2.99,9.06,2.21;2.60,2.50,3.04,P〈0.05）,while the SpO/ was significantly lower than that of ultrasound group at T1,T2 and T3（t=4.74,3.02,3.01,P〈0.05）. The incidences of coughing,nausea and restlessness of ultrasound group were significantly lower than those of the traditional group （x^2=4.71,4.32,4.63,P〈0.05）. The excellent and good rate of topi

关 键 词：超声 喉上神经内支阻滞 环甲膜穿刺 纤维支气管镜 

分 类 号：R614.2[医药卫生—麻醉学]