超声引导下喉上神经内支阻滞对悬雍垂腭咽成形术后患者应激反应的影响  

Influence of ultrasound-guided internal branch block of superior laryngeal nerve on stress response after uvula palatopharyngoplasty

作　　者：黄晓玲[1] 彭宣宣 唐轶珣 丁惠娟[1] Huang Xiaoling;Peng Xuanxuan;Tang Yixun;Ding Huijuan(Department of Anesthesiology,Hunan Provincial People′s Hospital(the First Affiliated Hospital of Hunan Normal University),Changsha 410005,China)

机构地区：[1]湖南省人民医院(湖南师范大学附属第一医院)麻醉科,长沙410005

出　　处：《中国医师杂志》2025年第3期397-401,共5页Journal of Chinese Physician

基　　金：长沙市科技局项目(kq1901060)。

摘　　要：目的评价超声引导下喉上神经内支阻滞对悬雍垂腭咽成形术(UPPP)患者术后留置气管导管期间应激反应的影响。方法回顾性选取湖南省人民医院2020年1月—2021年12月患有重度阻塞性睡眠呼吸暂停综合征需择期行UPPP的患者80例,将患者分为神经阻滞组(B组)和右美托咪啶组(D组)。B、D两组患者均接受全身麻醉,B组患者在术后苏醒前行超声引导下双侧喉上神经内支阻滞,D组患者手术结束前开始静脉泵注右美托咪啶。记录两组患者留置气管导管期间的呛咳评分与患者麻醉前(T_(1))、苏醒即刻(T_(2))、苏醒后2 h(T_(3))、6 h(T_(4))、12 h(T_(5))的平均动脉压(MAP)、HR、血浆肾上腺素(E)及去甲肾上腺素(NE)水平,以及T_(2)、T_(3)、T_(4)、T_(5)、术后24 h(T_(6))的视觉模拟量表(VAS)评分。结果与D组比较,B组患者呛咳评分显著更低,需补救镇痛的病例数显著更少(均P<0.01)。与T_(1)比较,B组T_(2)~T_(5)时点的MAP和HR以及D组T_(2)~T_(5)时点的HR,T_(2)时的MAP均明显升高(均P<0.05);与D组比较,B组T_(2)~T_(5)各时点MAP和HR均明显更高(均P<0.05)。与T_(1)比较,D组T_(2)~T_(5)时点的血清NE和E水平,B组T_(2)~T_(5)时点的血清NE和T_(2)的E水平均升高,差异有统计学意义(均P<0.05);与D组比较,B组T_(2)~T_(5)时的血清E和T_(2)~T_(4)时血清的NE水平明显更低(均P<0.05)。与T_(2)比较,B组T_(5)~T_(6) VAS评分明显下降,D组T_(3)~T_(6) VAS评分明显下降(均P<0.05)。与D组比较,B组T_(2)~T_(5)时间点的VAS评分均明显更低(均P<0.05)。结论与静脉使用右美托咪啶比较,超声引导下喉上神经内支阻滞能显著降低UPPP后患者带管期间的不适和应激反应,增加患者舒适度,减少术后并发症的发生率,促进患者快速康复。ObjectiveTo evaluate the effect of ultrasound-guided internal branch block of superior laryngeal nerve on stress response during endotracheal catheter indwelling in patients undergoing uvulopalatopharyngoplasty(UPPP).MethodsA total of 80 patients with severe obstructive sleep apnea syndrome requiring elective UPPP from the Hunan Provincial People′s Hospital from January 2020 to December 2021 were retrospectively selected and divided into nerve block group(group B)and dexmedetomidine group(group D).Patients in group B and D received general anesthesia.Patients in the group B received bilateral internal branch block of superior laryngeal nerve under ultrasound guidance before postoperative recovery.Patients in the group D received dexmedetomidine intravenously before the end of surgery.The cough scores and mean arterial pressure(MAP),heart rate(HR),plasma epinephrine(E)and norepinephrine(NE)levels of patients before anesthesia(T_(1)),immediately after recovery(T_(2)),2 h after recovery(T_(3)),6 h(T_(4)),and 12 h(T_(5))during endotracheal catheterization were recorded in both groups.The Visual Analogue Scale(VAS)scores of T_(2),T_(3),T_(4),T_(5) and 24 h after surgery(T_(6))were also obtained.ResultsCompared with group D,the cough scores of the group B patients were significantly lower,and the number of cases requiring remedial analgesia was significantly less(all P<0.01).Compared with T_(1),MAP and HR at T_(2)-T_(5) time points in the group B and HR and MAP at T_(2)-T_(5) time points in the group D were significantly increased(all P<0.05).Compared with the group D,MAP and HR were significantly higher than those at each time point of T_(2)-T_(5) in the group B(all P<0.05).Compared with T_(1),the serum NE and E levels in the group D at T_(2)-T_(5) time points,and the serum NE and T_(2) E levels in the group B at T_(2)-T_(5) time points were increased,and the differences were statistically significant(all P<0.05).Compared with the group D,serum E and serum NE levels at T_(2)-T_(5) and T_(2)-T_(4) in the group B were

关 键 词：睡眠呼吸暂停 阻塞性 悬雍垂腭咽成形术 神经传导阻滞 喉上神经 

分 类 号：R614[医药卫生—麻醉学]