超声下喉上神经阻滞复合右美托咪定对悬雍垂腭咽成形术后留置气管导管患者镇静镇痛的作用

Sedative and Analgesic Effects of Ultrasound-guided Superior Laryngeal Nerve Block Combined with Dexmedetomidine in Patients with Indwelling Tracheal Tube after Uvulopalatopharyngoplasty

目的:分析和研究超声下喉上神经阻滞复合右美托咪定对悬雍垂腭咽成形术后留置气管导管患者镇静镇痛的效果。方法:研究对象为2017年1月-2019年12月在笔者所在医院接受悬雍垂腭咽成形术后留置气管导管的100例患者,通过随机数字表法对全部患者实施分组,分为对照组与观察组,两组均为50例,对照组麻醉中使用右美托咪定,观察组采用超声下喉上神经阻滞复合右美托咪定。记录两组患者麻醉前(T_(0))、麻醉苏醒时(T_(1))、麻醉苏醒4 h(T_(2))及拔管前(T_(3))的心率(HR)、平均动脉压(MAP)。比较两组患者T_(1)、T_(2)、T_(3)的Ramsay镇静评分。比较两组苏醒后未使用舒芬太尼例数。结果:与T_(0)进行对比,两组T_(1)、T_(2)、T_(3)的HR及MAP明显升高,但观察组明显低于对照组,差异均有统计学意义(P<0.05)。观察组T_(1)、T_(2)、T_(3)的Ramsay评分明显高于对照组,差异均有统计学意义(P<0.05)。观察组苏醒后未使用舒芬太尼例数明显多于对照组,差异有统计学意义(P<0.05)。结论:将超声下喉上神经阻滞复合右美托咪定的麻醉方式应用于行悬雍垂腭咽成形术后留置气管导管患者具有明显的镇痛作用,值得临床采纳。

Objective:To analyze and study the sedative and analgesic effect of ultrasound-guided superior laryngeal nerve block combined with Dexmedetomidine in patients with indwelling tracheal tube after uvulopalatopharyngoplasty.Method:A total of 100 patients with indwelling tracheal tube after uvulopalatopharyngoplasty in our hospital from January 2017 to December 2019 were randomly divided into the control group and the observation group according to the random number method,with 50 cases in each group.The control group was anesthetized with Dexmedetomidine,while the observation group was anesthetized with superior laryngeal nerve block combined with Dexmedetomidine under ultrasound.The heart rate (HR) and mean arterial pressure (MAP) were recorded at different time points,including before anesthesia (T_(0)),anesthesia recovery (T_(1)),anesthesia recovery 4 h (T_(2)) and before extubation (T_(3)).Ramsay sedation scores of T_(1),T_(2) and T_(3) were compared between the two groups.The number of two groups do not need Sufentanil after awake was compared.Result:Compared with T_(0),HR and MAP of T_(1),T_(2),T_(3) of both group were significantly increased,but the observation group were significantly lower than those of the control group,the differences were statistically significant (P<0.05).The Ramsay scores of T_(1),T_(2),T_(3) of the observation group were significantly higher than those of the control group,the differences were statistically significant (P<0.05).The number of two groups without Sufentanil after awake of the observation group was significantly higher than that of the control group,the difference was statistically significant (P<0.05).Conclusion:Superior laryngeal nerve block combined with Dexmedetomidine anesthesia has obvious analgesic effect in patients with indwelling tracheal tube after uvulopalatopharyngoplasty,which is worthy of clinical adoption.