B超引导下喉上神经阻滞联合右美托咪啶在喉显微外科手术中的应用  

Application of B-ultrasound guided superior laryngeal nerve block combined with dexmedetomidine in laryngeal microsurgery

作　　者：邓丽珍[1] 李正民[2] 张春元[1] 蒋红娥 谭美云[1] DENG Lizhen;LI Zhengmin;ZHANG Chunyuan;JIANG Honge;TANMeiyun(Department of Anesthesiology,Pok Oi Hospital,Zhongshan City,Zhongshan,528403,China;Department of Otolaryngology,Pok Oi Hospital,Zhongshan City,Zhongshan,528403,China)

机构地区：[1]中山市博爱医院科室麻醉科,广东中山528403 [2]中山市博爱医院耳鼻喉科,广东中山528403

出　　处：《新疆医学》2020年第1期28-31,共4页Xinjiang Medical Journal

基　　金：中山市卫计局医学科研基金项目(2017J107)。

摘　　要：目的探讨B超引导下喉上神经阻滞联合右美托咪啶在喉显微外科手术中的应用效果。方法选择2017年1月-2019年3月在中山市博爱医院接受治疗的喉显微外科手术患者90例作为对象,采取病例对照方法,随机数字表分为A组(n=30)、B组(n=30)和C组(n=30)。A组给予常规全麻,B组在A组基础上给予右美托咪啶药物,而C组在B组基础上联合B超引导下喉上神经阻滞。比较三组患者麻醉前后T0、T1、T2、T3各时间点HR、MAP、血糖变化;支撑喉镜一次置入的成功率,手术时长、自主呼吸恢复时间、完全苏醒时间;维库溴胺平均用量与术后疼痛VAS评分等。结果与麻醉前T0时间点相比,A组麻醉后各时间点的心率、血压、血糖等应激反应指标有显著高于B组和C组,差异具有统计学意义(P<0.05),而B、C组的应激反应指标与麻醉前比较无统计学差异;与A组相比较,B、C组麻醉后T1、T2、T3时间点的各种应激指标均显著降低,差异有统计学意义(P<0.05,P<0.01);C组支撑喉镜一次置入成功率明显优于A、B组,差异具有统计学意义(P<0.01);C组的自主呼吸时间、完全苏醒时间、手术时长明显少于A、B组,维库溴胺平均用量更少,疼痛VSA评分更低,差异均具有统计学意义(P<0.01)。结论B超引导下喉上神经阻滞与右美托咪啶药物联合干预应用于喉显微外科手术中能有效降低患者术中的应激反应,缩短手术时长,减少损伤,加速患者苏醒和术后康复。Objective To investigate the effect of ultrasound-guided superior laryngeal nerve block combined with dexmedetomidine in laryngeal microsurgery.Methods Ninety patients with laryngeal microsurgery who were treated in Pok Oi Hospital of Zhongshan City from January 2017 to March 2019 were selected as subjects.A case-control method was used.All cases were divided into group A(n=30)and group B(N=30)and group C(n=30)according to the random number table.Group A received conventional general anesthesia,group B received dexmedetomidine on the basis of method in group A.Group C received superior laryngeal nerve block under the guidance of ultrasound on the basis of method in group B.Changes in HR,MAP,and blood glucose at various time points of T0,T1,T2,and T3 before and after anesthesia in three groups were compared.And the success rate of one-time laryngoscope support,length of surgery,spontaneous breathing recovery time,and completely waking time;mean vecuronium dosage and postoperative pain VAS score in three groups were compared too.Results Compared with the time point T0 before anesthesia,the stress response indexes such as heart rate,blood pressure and blood glucose at each time point after anesthesia in group A were significantly higher than those in groups B and C,with statistically significant differences(P<0.05).while the stress response indexes of groups B and C showed no statistically significant differences compared with those before anesthesia.Compared with group A,various stress indicators at time points T1,T2 and T3 after anesthesia were significantly decreased in groups B and C,with statistically significant differences(P<0.05,P<0.01);The success rate of primary placement of support laryngoscope in group C was significantly better than that in groups A and B,with statistically significant difference(P<0.01);The spontaneous breathing time and full waking time and operation time in group C were significantly less than those in groups A and B,the average dosage of vecuronium was lower,and the pain VSA score w

关 键 词：喉显微外科手术 喉上神经阻滞 右美托咪啶 联合 

分 类 号：R762[医药卫生—耳鼻咽喉科]