改进局部神经阻滞在鼻中隔偏曲矫正术中的应用观察

Application of improved local nerve block anesthesia in correction of nasal septum surgery

目的观察改进局部神经阻滞在鼻中隔偏曲矫正术中的效果。方法151例单纯行鼻中隔偏曲矫正术的患者中，72例采用常规局部神经阻滞（常规组），行蝶腭神经＋筛前神经阻滞；79例采用改进局部神经阻滞（改进组），行蝶腭神经＋筛前神经＋切牙管神经阻滞。比较两组麻醉效果。结果改进组和常规组未处理鼻底骨嵴患者麻醉成功率比较差异无统计学意义[100．0％（41／41）比97．3％（36／37），P〉0．05]；改进组处理鼻底骨嵴患者麻醉成功率明显高于常规组[92．1％（35／38）比45．7％（16／35）]，差异有统计学意义（r=18．623，P〈0．05）。两组患者均未发生麻醉药过敏、中毒及一过性血压下降和／或心跳、呼吸暂停等麻醉意外。结论根据鼻腔鼻窦感觉神经分布特点，结合鼻内镜技术，对于不需要处理鼻底骨嵴的鼻中隔偏曲矫正术，可以选择蝶腭神经＋筛前神经阻滞的常规局部神经阻滞方式，对于需要处理鼻底骨嵴的鼻中隔偏曲矫正术，则首选蝶腭神经＋筛前神经＋切牙管神经阻滞的改进局部神经阻滞方式。

Objective To explore the effect of improved local nerve block anesthesia in correction of nasal septum surgery. Methods One hundred and fifty-one cases of patients with simply received correction of nasal septum surgery were divided into two groups,72 cases with normal local nerve block （normal group ）, receiving sphenopalatine and anterior ethmoidal nerve block anesthesia; 79 cases with the improved local nerve block （improved group）, receiving sphenopalatine, anterior ethmoidal and incisive canal nerve b[ock anesthesia. Two groups of anesthesia success and anesthesia effect were compared. Results The anesthesia success rates of improved group and normal group who were performed correction of nasal septum surgery without removal of the nasal bottom ridge were 100.0% （41/41 ） and 97.3 % （36/37）, there was no significant difference （P〉 0.05 ）. But for 73 eases who were performed correction of nasal septum surgery with removal of the nasal bottom ridge, the anesthesia sueeess rate in improved group was higher than that in normal group [92.1%（35/38） vs. 45.7%（ 16/35）], there was significant difference （ X^2 = 18.623,P〈 0.05）. Conclusions Based on the distribution eharaeteristies of sensory nerves of the nasal cavity, and eombined with endoseopie teehniques, the eonventional sphenopalatine and anterior ethmoidal nerve bloek anesthesia is suitable for nasal septum surgery without removal of the nasal bottom ridge and the advanced sphenopalatine, anterior ethmoidal and incisive canal nerve block anesthesia is the first ehoiee for nasal septum surgery with removal of the nasal bottom ridge.