超声引导下喉上神经阻滞在清醒盲探经鼻气管插管中的应用

Application of Ultrasound-guided Superior Laryngeal Nerve Block for Awake Nasotracheal Intubation

目的探讨超声引导下喉上神经阻滞(superior laryngeal nerve block,SLNB)在清醒盲探经鼻气管插管中的临床应用效果。方法收集90例符合纳入标准的颈椎手术患者作为观察对象,按随机数字表法分为对照组(30例)、传统组(30例)和超声组(30例)。对照组给予表面麻醉联合环甲膜穿刺后行清醒盲探经鼻气管插管,传统组通过解剖定位法行喉上神经阻滞后给予表面麻醉联合环甲膜穿刺后行清醒盲探经鼻气管插管,超声组在超声引导下喉上神经阻滞后给予表面麻醉联合环甲膜穿刺后行清醒盲探经鼻气管插管。记录3组患者麻醉诱导前(T0)、气管导管通过声门即刻(T1)、气管导管进入气管后1 min(T2)血流动力学指标;记录呛咳、躁动及恶心呕吐(postoperative nausea and vomiting,PONV)等不良反应的发生情况和术后第1天回访患者的满意度。结果对照组T1-T2时点HR、MAP水平高于T0(P<0.05),T1时点SpO2低于T0(P<0.05);传统组T1-T2时点HR、MAP水平高于T0(P<0.05);传统组和超声组呛咳反应、躁动评分及术后恶心呕吐发生率低于对照组(P均<0.05),术后第1天患者满意度评价优良率高于对照组(P<0.05);超声组呛咳反应和躁动评分低于传统组(P<0.05),术后第1天患者满意度评价优良率高于传统组(P<0.05)。结论超声引导下喉上神经阻滞用于经鼻清醒气管插管颈椎手术患者,可维持血流动力学平稳,减轻呛咳反应和躁动反应,降低术后恶心呕吐的发生率,提高患者满意度。

Objective To investigate the clinical application value of ultrasound-guided superior laryngeal nerve block(SLNB)for awake blind nasal intubation.Methods Ninety patients with cervical spine surgery who met the criteria were enrolled in this study.They were randomly divided into the control group(n=30),the traditional group(n=30)and the ultrasound group(n=30).The control group was given a surface anesthesia combined with a cricothyroid membrance before undergoing awake Nasotracheal intubation.The traditional group was given a surface anesthesia combined with a cricothyroid membrance after laryngeal nerve block by acupoint-located method by anatomical landmark.The ultrasound group underwent ultrasound-guided superior laryngeal nerve block combined with cricothyroid membrance and surface anesthesia before awake Nasotracheal intubation.Hemodynamic indexes were recorded before anesthesia induction(T0),immediately after tracheal tube passing through glottis(T1)and 1min after tracheal tube entering trachea(T2);incidence of adverse reactions such as cough,postoperative nausea and vomiting(PONV)and satisfaction of patients on the first day after operation were recorded.Results The levels of HR and MAP in T1-T3 were higher than T0(P<0.05),and SpO2 in T1 was lower than T0(P<0.05).The levels of HR and MAP in T1-T2 were higher than T0 in traditional group(P<0.05).The incidence of cough response,agitation score and postoperative nausea and vomiting in the traditional group and the ultrasound group were lower than those in the control group(P<0.05).The cough response and agitation score in the ultrasound group were lower than those in the traditional group(P<0.05).The excellent rate and satisfaction evaluation on the first day after operation was higher than that in the traditional group(P<0.05).Conclusion Ultrasound-guided superior laryngeal nerve block for patients undergoing nasal awake Nasotracheal intubation can maintain hemodynamic stability,reduce cough response and agitation,reduce the incidence of postoperative nausea and vomiting,and improve patient satisfaction.