超声引导喉上神经阻滞联合静脉麻醉用于纤维支气管镜诊疗术患儿的改良效果  

Efficacy of ultrasound-guided superior laryngeal nerve block combined with intravenous anesthesia for improving pediatric fiberoptic bronchoscopy

作　　者：姚忠岩[1] 娄宁 齐曼曼 王玉 刘旺 孙秀伟[1] 汤国亮[3] Yao Zhongyan;Lou Ning;Qi Manman;Wang Yu;Liu Wang;Sun Xiuwei;Tang Guoliang(Department of Anesthesiology,Cangzhou Central Hospital,Cangzhou 061000,China;Department of Hip-Traumatology,Cangzhou Hospital of Integrated TCM-WM·Hebei,Cangzhou 061000,China;Department of Anesthesiology,Nanpi County People′s Hospital,Nanpi 061500,China)

机构地区：[1]沧州市中心医院麻醉科,沧州061000 [2]河北省沧州中西医结合医院髋部创伤科,沧州061000 [3]沧州市南皮县人民医院麻醉科,南皮061500

出　　处：《中华麻醉学杂志》2023年第10期1197-1200,共4页Chinese Journal of Anesthesiology

摘　　要：目的评价超声引导喉上神经阻滞联合静脉麻醉用于纤维支气管镜诊疗术患儿的改良效果。方法选择本院纤维支气管镜诊疗术患儿40例,年龄3~6岁,ASA分级Ⅰ或Ⅱ级,性别不限,BMI 18~24 kg/m^(2),采用随机数字表法分为2组(n=20):超声引导喉上神经阻滞+静脉麻醉组(A组)和表面麻醉+静脉麻醉组(B组)。采用右美托咪定与艾司氯胺酮镇静后,A组行超声引导双侧喉上神经阻滞,双侧各注射1%利多卡因0.5 ml;B组行1%利多卡因鼻腔、咽腔部表面麻醉。操作完成后,静脉泵注丙泊酚5 mg·kg^(-1)·h^(-1)维持至诊疗完成。术中若出现剧烈呛咳或体动,静脉追加丙泊酚1 mg/kg。于入室时(T_(0))、麻醉镇静后即刻(T_(1))、支气管镜进入声门即刻(T_(2))、诊疗术开始后5 min(T_(3))及检查完成(T4)时记录MAP、HR和SpO_(2)。记录术中低氧血症、HR<60次/min、MAP<50 mmHg的发生情况,记录丙泊酚追加剂量。于T_(0)与T4时采集静脉血样,采用化学发光法测定血浆皮质醇浓度。记录术者满意度评分。记录A组患儿术后2 h内喉上神经阻滞相关并发症的发生情况。结果与B组比较,A组T_(2)、T_(3)时HR降低,SpO_(2)升高,术中丙泊酚追加剂量和低氧血症发生率降低,术者满意度评分升高,T4时血浆皮质醇浓度降低(P<0.05)。2组术中均未见HR<60次/min、MAP<50 mmHg的情况发生。A组术后未见喉上神经阻滞相关并发症发生。结论超声引导喉上神经阻滞联合静脉麻醉用于纤维支气管镜诊疗术患儿安全性较高,相比常规麻醉可提高镇痛效果,更有利于抑制术中应激反应。Objective To evaluate the efficacy of ultrasound-guided superior laryngeal nerve block(SLNB)combined with intravenous anesthesia for improving pediatric fiberoptic bronchoscopy.Methods Forty pediatric patients of either sex,aged 3-6 yr,of American Society of Anesthesiologists Physical Status classificationⅠorⅡ,with body mass index of 18-24 kg/m^(2),undergoing fiberoptic bronchoscopy in Cangzhou Central Hospital in 2022,were divided into 2 groups(n=20 each)by a random number table method:ultrasound-guided SLNB plus intravenous anesthesia group(group A)and topical anesthesia plus intravenous anesthesia group(group B).After sedation with dexmedetomidine and esketamine,ultrasound-guided bilateral SLNB was performed with 1%lidocaine 0.5 ml(for each side)in group A,and topical anesthesia was performed with 1%lidocaine in nasal and pharyngeal cavities in group B.After completion of the surgery procedure,propofol was continuously infused at 5 mg·kg^(-1)·h^(-1)until completion of diagnosis and treatment.An increment of propofol 1 mg/kg was intravenously given if severe bucking or body movement occurred during operation.Mean arterial pressure(MAP),heart rate(HR)and SpO_(2)were recorded on admission to the operating room(T_(0)),immediately after sedation(T_(1)),immediately after bronchoscopy entering the glottis(T_(2)),5 min after start of treatment(T_(3))and at the end of examination(T4).The occurrence of intraoperative hypoxemia,HR<60 bpm,and MAP<50 mmHg were recorded,and the additional dose of propofol was recorded.The venous blood samples were collected at T_(0)and T4 to determine plasma cortisol concentrations by chemiluminescence.The surgeon′s satisfaction score was recorded.The complications of SLNB were also recorded within 2 h after operation in group A.Results Compared with group B,HR was significantly decreased at T_(2)and T_(3),SpO_(2)was increased,the intraoperative additional dosage of propofol and incidence of hypoxemia were decreased,and the surgeon′s satisfaction score was increased,and the concen

关 键 词：神经传导阻滞 喉神经 超声检查 儿童 支气管镜检查 

分 类 号：R726.1[医药卫生—儿科]