喉上神经阻滞复合静脉麻醉在支撑喉镜下声带息肉摘除术中的临床研究

Clinical application of intravenous anethesia combined with superior laryngeal nerve block in laryngoscopic vocal cord polypectomy

目的评估喉上神经阻滞复合静脉麻醉在支撑喉镜下声带息肉摘除术中的临床效果。方法将40例拟行支撑喉镜下声带息肉摘除术患者随机分为两组,每组20例。Ⅰ组采用全凭静脉麻醉,Ⅱ组行双侧喉上神经阻滞,10 min后给予复合静脉麻醉。麻醉维持采用丙泊酚和瑞芬太尼[0.2μg/(kg.min)],维持脑电双频指数40～60。记录围术期收缩压(SBP)、舒张压(DBP)、心率(HR)及血糖和血浆去甲肾上腺素(NE)的值。结果与诱导前比较,两组患者各时间点的SBP、DBP、血糖、NE值均升高,HR在置入喉镜后出现降低,其他时间点均升高;与Ⅰ组对比,Ⅱ组患者的各值变化较小,相对更稳定。结论相对于全凭静脉麻醉,喉上神经阻滞复合静脉麻醉应用于支撑喉镜下声带息肉摘除术对于围术期的应激反应抑制较好,心血管系统的变化也更加稳定,术后不良反应较少,在临床上有一定的应用价值。

Objective To evaluate the clinical effect of intravenous anesthesia combined with superior laryngeal nerve block on laryngoseopic vocal cord polypeetomy. Methods Forty patients underwent laryngoscopic vocal cord polypectcmy were randomly allocated into two groups. In group I, anesthesia only depended on the intravenous drugs. In groupⅡ , patients were first managed with bilateral blocking of superior laryngeal nerve; 10 minutes later, compound intravenous anesthesia was initiated. The anesthesia state was maintained by intravenous Propofol and Remifentanil, and monitoring the BIS around 40 to 60. The following perioperational parameters, including systolic blood pressure, diastolic blood pressure, heart rate, serum glucose and NE were recorded. Results The induction with anesthesia can increase the SBP, DBP, GLU and NE levels in both group, the heart rate decreased at the point during the insertion of laryngoscopy. The parameters recorded were more stable in group 11 tharl those in group I ~ Conclusion Compared with the anesthesia based on intravenous methods, the combination of superior laryngeal nerve bloking and intravenous drugs has superiority in emergency reaction suppression, stable cardiologic changes and less adverse effects, so is worth clinical application.