超声引导下罗哌卡因喉上神经内支阻滞用于支撑喉镜下喉癌切除术的效果

Clinical effect of Ropivacaine ultrasound-guided internal branch of superior laryngeal nerve block for laryngeal carcinoma resection by suspension laryngoscope

目的探讨0.2%罗哌卡因超声引导双侧喉上神经内支(ibSLN)阻滞用于支撑喉镜下喉癌CO_(2)激光切除术的效果。方法60例于2021年11月至2021年12月在首都医科大学附属北京同仁医院择期行支撑喉镜下喉癌CO_(2)激光切除术患者,按随机数字表法分为对照组和观察组,每组30例。对照组采用全身麻醉(全麻)插管,观察组行超声引导下双侧ibSLN阻滞(0.2%罗哌卡因2 mL)+全麻插管。记录入室时(T_(0))、气管插管进入声门即刻(T_(1))、支撑喉镜置入成功即刻(T_(2))、支撑喉镜置入成功后5 min(T_(3))、拔管即刻(T4)、拔管后5 min(T_(5))的心率(HR)、平均动脉压(MAP);记录拔管时间,拔管后即刻、拔管后6 h的视觉模拟评分(VAS);观察并记录两组术后呛咳、误吸、呼吸困难等不良反应发生情况及回访患者的满意度。结果与对照组相比,观察组T_(1)~T_(5)各时间点HR、MAP值明显降低(P<0.05);与T_(0)相比,对照组麻醉后各时间点HR、MAP均有升高(P<0.05),观察组各时间点HR、MAP差异均无统计学意义(P>0.05)。拔管时间观察组明显短于对照组[(9.3±1.6)min比(13.8±1.2)min,P<0.05],观察组拔管后即刻、拔管后6 h的VAS评分较对照组明显降低[(2.52±1.85)分比(5.23±2.21)分;(1.23±0.29)分比(4.19±0.88)分,P<0.05],观察组患者满意度评分为优良者例数高于对照组(29例比18例,P<0.05),两组患者均未发生不良反应。结论超声引导下0.2%罗哌卡因双侧ibSLN阻滞用于支撑喉镜下喉癌切除术效果确切,能更好地保持术中血流动力学平稳,缩短拔管时间,减少患者术后不适,实现患者的舒适化医疗及快速康复。

Objective To investigate the effect of ultrasound(US)-guided bilateral internal branch of superior laryngeal nerve(ibSLN)block by 0.2%Ropivacaine for CO_(2)laser resection of laryngeal carcinoma by suspension laryngoscope.Methods Sixty patients scheduled for elective CO_(2)laser resection of laryngeal carcinoma by laryngoscope in Beijing Tongren Hospital Affiliated to Capital Medical University from November 2021 to December 2021 were randomly divided into control group and observation group,with 30 cases in each group.The control group was intubated under general anesthesia,while the observation group was US-guided bilateral ibSLN block by 0.2%Ropivacaine 2 mL.The heart rate(HR),and mean arterial pressure(MAP)were detected at the time of patients entering the operating room(T_(0))、immediately after intubation(T_(1)),suspensing laryngoscopy(T_(2)),5 min after suspensing laryngoscopy(T_(3)),immediately after extubation(T_(4)),and 5 min after extubation(T_(5)).Extubation time and the visual analogue score(VAS)were recorded immediately after extubation and 6 hours after extubation.Adverse reactions in the two groups such as choking,aspiration,dyspnea were observed,while the score of patients’satisfaction was evaluated.Results Compared with control group,the values of HR and MAP at each time point from T_(1)to T_(5)in observation group were significantly decreased(P<0.05);compared with T_(0),the values of HR and MAP at each time point after anesthesia in the control group were significantly increased(P<0.05),and there were no significant difference in observation group.The extubation time in observation group was significantly shorter than that in control group[(9.3±1.6)min vs.(13.8±1.2)min,P<0.05].VAS score immediately after extubation and 6 hours after extubation in observation group was significantly decreased[(2.52±1.85)vs.(5.23±2.21);(1.23±0.29)vs.(4.19±0.88),all P<0.05].People with excellent satisfaction score in observation group was significantly higher than that in control group(29 cases vs.18 cases,P<0.05).There was no adverse reaction in the two group.Conclusion US-guided 0.2%Ropivacaine bilateral ibSLN block has an accurate effect,which can better maintain the stability of intraoperative hemodynamics,shorten the extubation time,reduce postoperative discomfort,and achieve comfortable medical treatment and rapid recovery of patients.