超声引导下喉上神经阻滞联合气管内表面麻醉对老年高血压患者插管反应的影响

Effects of superior laryngeal nerve block combined with intratracheal surface anesthesia on stress response in elderly hypertensive patients undergoing double-lumen tracheal intubation

目的观察超声引导下喉上神经阻滞联合气管内表面麻醉对老年高血压患者双腔气管插管反应的影响。方法择期全麻下行单肺通气胸科手术的高血压患者60例,男37例,女23例,年龄65~85岁,ASA Ⅱ或Ⅲ级,随机分为喉上神经阻滞联合气管内表面麻醉组(S组)和对照组(C组),每组30例。于入室时(T_0)、插管前即刻(T_1)、插管即刻(T_2)、插管成功后1min(T_3)、3min(T_4)、5min(T_5)、10min(T_6)颈内静脉采血,测定血浆肾上腺素(E)和去甲肾上腺素(NE)浓度。记录诱导插管期间高血压、低血压、心动过速和心动过缓等不良事件的发生情况。结果与T_0时比较,T_2~T_5时C组E和NE浓度明显升高(P<0.05或P<0.01);T_2~T_5时S组E和NE浓度明显低于C组(P<0.05或P<0.01)。诱导插管期间S组高血压发生率明显低于C组(0% vs 37%,P<0.01),两组均未发生低血压、心动过速和心动过缓等不良事件。结论超声引导下喉上神经阻滞联合气管内表面麻醉可有效抑制老年高血压患者双腔气管插管反应,有利于维持麻醉诱导期间的血流动力学稳定。

Objective To observe the effects of ultrasound-guided laryngeal nerve block combined with intratracheal surface anesthesia on the intubation reaction of double-lumen endotracheal tube in elderly hypertensive patients.Methods Sixty elderly hypertensive patients,including 37 males and 23 females,with ASA physical status Ⅱ or Ⅲ,aged 65-85 years,scheduled for thoracic surgery under general anesthesia requiring one-lung ventilation,were equally and randomly divided into either laryngeal nerve block combined with intratracheal surface anesthesia group（group S）or general anesthesia group（group C）.Internal jugular vein blood samples were taken to measure the plasma concentrations of epinephrine（E）and norepinephrine（NE）when patients entering the operating room（T0）,before intubation（T1）,immediately after intubation（T2）,at 1 min（T3）,3 min（T4）,5 min（T5）and 10 min（T6）after intubation.Adverse events,such us hypertension and tachycardia,were recorded during induction and intubation.Results Compared with T0,the plasma concentrations of E and NE were significantly increased at T2-T5 in group C（P〈0.05 or P〈0.01）,while there were no such significant changes in group S.The plasma concentration of E and NE at T2-T5 in group S were significantly lower than that in group C（P〈0.05 or P〈0.01）.The incidence of hypertension in group S was significantly lower than that in group C during induction of intubation（0% vs 37%,P〈0.01）.There were no hypotension,tachycardia and bradycardia during induction and intubation in both groups.Conclusion Ultrasound-guided laryngeal nerve block combined with intratracheal surface anesthesia can effectively inhibit the intubation reaction of double-lumen endotracheal tube in elderly hypertensive patients,which is helpful for maintaining the hemodynamic stability during anesthesia induction.