超声引导下喉上神经阻滞联合环甲膜穿刺在支气管镜介入治疗中的应用

Applications of ultrasound-guided superior laryngeal nerve block combined with cricothyroid membrane puncture in bronchoscope interventional treatment

目的评价超声引导下喉上神经阻滞联合环甲膜穿刺在支气管介入治疗中的应用价值。方法择期行支气管镜介入治疗患者40例,年龄19~76岁,体质指数(BMI)19~23 kg/m^2,美国麻醉医师协会分级(ASA)为Ⅱ级或Ⅲ级,采用随机数字表法,将患者分为两组,每组20例:对照组(C组)和超声组(U组)。两组患者均采取保留自主呼吸喉罩全麻,U组在麻醉诱导前行超声引导下喉上神经阻滞联合环甲膜穿刺,C组在麻醉诱导后经支气管镜行表面麻醉。术中靶控输注丙泊酚和瑞芬太尼,维持脑电双频指数(BIS)值40~60。记录两组患者诱导前(T0)、置入喉罩时(T1)、手术开始时(T2)、手术开始10 min(T3)及拔除喉罩时(T4)的平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO2)、呼气末二氧化碳分压(PETCO2)和BIS值;记录苏醒时间、术中呛咳发生率、单位时间麻醉药物用量和手术医师满意度评分等。结果两组患者各时点MAP、HR、SpO2、PETCO2和BIS值比较,差异均无统计学意义(P>0.05);与C组相比,U组术中呛咳发生率降低,单位时间丙泊酚和瑞芬太尼用量明显减少,苏醒时间缩短,手术医师满意度评分更高,两组比较,差异均有统计学意义(P<0.05)。结论超声引导下喉上神经阻滞联合环甲膜穿刺应用于支气管镜介入治疗中,安全、有效,优势明显。

Objective To evaluate the value of ultrasound-guided superior laryngeal nerve block combined with cricothyroid membrane puncture in bronchoscope interventional treatment.Methods Forty patients,aged 19~76 y,with body mass index of 19~23 kg/m2,of American Society of Anesthesiologists physical statusⅡorⅢ,scheduled for elective bronchoscope interventional treatment,were randomly divided into control group(group C)and ultrasound group(group U)with 20 patients in each group using a random number table.Patients in both groups were given general anesthesia with laryngeal mask in spontaneously breathing,ultrasound-guided superior laryngeal nerve block combined with cricothyroid puncture before anesthesia induction in group U,surface anesthesia was performed by bronchoscopy after anesthesia induction in group C.Propofol and Remifentanil were infused by target controlled infusion to maintain Bispectral index value of 40~60 during the operation.Before anesthesia induction(T0),at the time of laryngeal mask insertion(T1),at the beginning of operation(T2),at 10 min after operation beginning(T3)and at the time of laryngeal mask removal(T4),MAP,HR,SpO2,PETCO2 and Bispectral index value were recorded.Recovery time,incidence of intraoperative cough,dosage of anesthetic per unit time,satisfaction score of surgeons were also recorded.Results The MAP,HR,SpO2,PETCO2 and Bispectral index value were not statistically different at the point of time between the two groups(P>0.05).Compared with group C,the incidence of choking cough,the dosage of Propofol and Remifentanil per unit time were significantly reduced,the recovery time was shortened,and the satisfaction score of surgeons was higher in group U(P<0.05).Conclusion Ultrasound-guided superior laryngeal nerve block combined with cricothyroid membrane puncture is safe,effective and has obvious advantages in bronchoscope interventional treatment.