超声引导下喉上神经阻滞结合环甲膜穿刺用于困难气道清醒插管的临床研究  

Clinical study on ultrasound-guided superior laryngeal nerve block combined with cricothyroid membrane puncture for awake tracheal intubation in difficult airways

作　　者：朴慧英 朱正宁 Piao Huiying;Zhu Zhengning(Department of Anesthesiology,Marine Police Corps Hospital of Chinese People's Armed Police Force,Jiaxing 314000,Zhejiang Province,China)

机构地区：[1]武警海警总队医院麻醉科,嘉兴314000

出　　处：《中国基层医药》2024年第1期45-51,共7页Chinese Journal of Primary Medicine and Pharmacy

基　　金：浙江省嘉兴市公益性研究计划(2022AD30128)。

摘　　要：目的评价超声引导下喉上神经阻滞结合环甲膜穿刺用于困难气道清醒插管的临床效果。方法采用前瞻性研究,以2019年8月至2023年2月武警海警总队医院择期进行全身麻醉手术的困难气道患者80例为研究对象,采用随机数字表法分为对照组(40例)和观察组(40例)。两组患者均实施纤维支气管镜(FOB)引导下经鼻清醒气管插管,插管前对照组实施表面麻醉结合环甲膜穿刺麻醉,对观察组实施超声引导下喉上神经阻滞(SLNB)联合环甲膜穿刺麻醉。监测患者插管过程中血流动力学指标,记录插管操作耗时,评价插管过程中镇静及呛咳反应程度,检测插管前后血清应激反应因子含量,调查患者对于插管操作的满意度。结果观察组气管导管进入声门即刻(T1)、气管导管进入气管后(T2)时点心率(HR)依次为(84.08±8.25)次/分,(82.64±7.81)次/分、平均动脉压(MAP)依次为(92.57±8.32)mmHg(1 mmHg=0.133 kPa),(103.27±9.16)mmHg均显著低于对照组(t=5.92~12.56,P<0.001),观察组与对照组各时点血氧饱和度(SpO_(2))差异均无统计学意义(t=0.34~0.43,P=0.652~0.726);观察组插管操作耗时(8.96±1.15)min,显著短于对照组的(11.47±1.39)min(t=6.84,P<0.001);观察组插管过程中Ramsay镇静评分3(2,3)分,显著高于对照组的2(1,3)分;而呛咳反应评分1(0,1)分,显著低于对照组的1(0,2)分(Z=9.26、4.37,均P<0.001);观察组血清去甲肾上腺素(NE)和肾上腺素(E)等应激反应因子含量均显著低于对照组(t=14.58~25.94,均P<0.05);观察组对于插管操作的总体满意度(97.50%)显著高于对照组(χ^(2)=4.51,P=0.034)。结论SLNB结合环甲膜穿刺用于困难气道清醒经鼻气管插管的麻醉管理,可提高患者血流动力学稳定性和镇静程度,缩短气管插管操作耗时,减轻操作过程应激反应,提高患者治疗满意度。Objective To evaluate the clinical efficacy of ultrasound-guided superior laryngeal nerve block combined with cricothyroid membrane puncture for awake tracheal intubation in difficult airways.Methods A total of 80 patients scheduled for general anesthesia surgery owing to difficult airways at Marine Police Corps Hospital of Chinese People's Armed Police Force from August 2019 to February 2023 were included in this prospective study.These patients were randomly divided into a control group and an observation group(n=40 per group).Both groups of patients underwent fiberoptic bronchoscope-guided awake tracheal intubation through the nasal route.Before intubation,the control group received surface anesthesia combined with cricothyroid membrane puncture anesthesia,while the observation group received superior laryngeal nerve block combined with cricothyroid membrane puncture anesthesia.During the intubation process,hemodynamic indicators of the patients were monitored,the duration of the intubation operation was recorded,and the degree of sedation and cough response was evaluated.Before and after intubation,the levels of serum stress response factors were determined,and the satisfaction level of patients with the intubation operation was investigated.Results At the time points T1(immediately after the tracheal tube enters the glottis)and T2(after the tracheal tube enters the trachea),the heart rate in the observation group was(84.08±8.25)times/minute and(82.64±7.81)times/minute,respectively,and the mean arterial pressure in the observation group was(92.57±8.32)mmHg(1 mmHg=0.133 kPa)and(103.27±9.16)mmHg,respectively,which were significantly lower compared with those in the control group(t=5.92-12.56,all P<0.001).At T1 and T2,there was no significant difference in blood oxygen saturation(SpO_(2))between the observation and control groups(t=0.34-0.43,P=0.652-0.726).The duration of the intubation operation in the observation group was(8.96±1.15)minutes,which was significantly shorter than(11.47±1.39)minutes in the c

关 键 词：插管法 气管内 超声检查 自主神经传导阻滞 喉神经 支气管镜检查 应激 生理学 血流动力学 病人满意度 

分 类 号：R614[医药卫生—麻醉学]