超声引导下喉上神经内支阻滞联合气道内表面麻醉对七氟醚吸入诱导气管插管半数有效浓度的影响  

The median effective intubation concentration of sevoflurane in patients undergoing ultrasound-guided internal branch of superior laryngeal nerve block combined with airway topical anesthesia

作　　者：王丹凤[1] 戴东升[1] 林莹[1] 郑晓春[1] Wang Danfeng;Dai Dongsheng;Lin Ying;Zheng Xiaochun(Department of Anesthesialogy,Fujian Provincial Hospital,Fuzhou 350001,China)

机构地区：[1]福建省立医院麻醉科,福州350001

出　　处：《国际麻醉学与复苏杂志》2018年第10期977-981,991,共6页International Journal of Anesthesiology and Resuscitation

摘　　要：目的 比较超声引导下喉上神经内支（internal branch of superior laryngeal nerve, iSLN）阻滞及其联合气道内表面麻醉对七氟醚吸入诱导气管插管时半数有效浓度（50% effective concentration, EC50）的影响。 方法 择期行气管插管全身麻醉患者96例，ASA 分级Ⅰ、Ⅱ级，BMI 18.5～24.9 kg/m^2；采用随机数字表法将患者分为2组（每组48例）：超声引导下iSLN阻滞组（iSLN组）和超声引导下iSLN阻滞联合气道内表面麻醉组（联合组），分别接受超声引导下iSLN阻滞或iSLN联合气道内表面麻醉，采用区组随机法将各组患者分为4个亚组（每组12例），分别在0.7、1.0、1.4、2.0 MAC七氟醚麻醉深度下行可视喉镜引导气管插管。记录插管前及插管后5 min内SBP、DBP和HR的峰值，以插管5 min内峰值SBP和/或HR增加≥30%基础值为有显著临床意义的插管应激，采用非线性拟合模型绘制两组患者气管插管七氟醚的量效曲线，并计算其气管插管的EC50及其95%CI。 结果 超声引导下iSLN阻滞七氟醚吸入诱导气管插管的EC50为1.330 MAC（95%CI：1.197～1.478 MAC）、EC95为1.999 MAC，超声引导下iSLN阻滞联合气道内表面麻醉七氟醚吸入诱导气管插管的半数有效浓度（50% effective concentration, EC50）为1.214 MAC（95%CI：0.997～1.479 MAC）、95%有效浓度（95% effective concentration, EC95）为1.545 MAC。 结论 超声引导下iSLN阻滞及其联合气道内表面麻醉均可有效控制气管插管的应激反应，且联合应用对插管应激的控制更佳。Objective To compare the median effective intubation concentration of sevoflurane in patients undergoing ultrasound-guided internal branch of superior laryngeal nerve（iSLN） block combined with or without airway topical anesthesia. Methods Ninety-six patients, ASA Ⅰ or Ⅱ,BMI 18.5-24.9 kg/m2,scheduled for selective surgery under general anesthesia with tracheal intubation. Patients were randomly assigned into 2 groups in which received ultrasound-guided iSLN block combined with or without airway topical anesthesia. Thereafter, patients were randomly assigned into 4 subgroups in which received tracheal intubation by Airtraq under 0.7, 1.0, 1.4, or 2.0 MAC sevoflurane by block randomization respectively. SBP, DBP, and HR before intubation to 5 min were recorded. An increase of more than 30% baseline of SBP and/or HR during the period was considered as clinical significant. The non-line fit model was performed to build the dose-effect curve. Based on the dose-effect curve, intubation EC50 and their 95%CI in 2 groups were calculated. Results Intubation 50% effective concentration（EC50） and 95% effective concentration（EC95） of sevoflurane in ultrasound-guided iSLN block group were 1.330 MAC （95%CI： 1.197-1.478） and 1.999 MAC respectively. The numbers in ultrasound-guided iSLN block combined with airway topical anesthesia group were 1.214 MAC （95%CI： 0.997-1.479） and 1.545 MAC. Conclusions Both ultrasound-guided iSLN block combined with and without airway topical anesthesia performed well in stress control in tracheal intuation. But the combination method has best effect.

关 键 词：喉上神经内支 神经阻滞 七氟醚 气管插管 半数有效浓度 

分 类 号：R614[医药卫生—麻醉学]