超声引导喉上神经阻滞与丁卡因表面麻醉在支撑喉镜喉癌切除术中的麻醉效果比较

Comparison of the anesthetic effects between ultrasound-guided superior laryngeal nerve block and tetracaine topical anesthesia in supporting laryngoscope for laryngeal carcinoma resection

目的比较超声引导喉上神经阻滞与丁卡因表面麻醉用于支撑喉镜下喉癌二氧化碳激光切除术的麻醉效果,为进一步优化麻醉方案提供临床依据。方法选择2022年6—9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二氧化碳激光切除术患者64例,年龄40~70岁,按随机数字表法分为2组:丁卡因表面麻醉+全身麻醉插管组(D组,n=32),在口咽、会厌、杓状软骨区喷入1%丁卡因1.5 ml,共2次(3 ml)后行全身麻醉诱导气管插管;超声引导双侧喉上神经阻滞+全身麻醉插管组(S组,n=32),超声引导双侧喉上神经阻滞(0.2%罗哌卡因3 ml)后行全身麻醉诱导气管插管。分别记录2组患者入室后(T_(1))、气管插管进入声门即刻(T_(2))、支撑喉镜置入成功即刻(T_(3))、支撑喉镜置入成功后3 min(T_(4))、拔管即刻(T_(5))、拔管后3 min(T_(6))的平均动脉压(MAP)、心率。记录2组患者术后苏醒指标(包括肌松恢复时间、气管拔管时间)以及不良反应发生情况。记录拔管后即刻和拔管后2、6、12、24 h咽喉痛的视觉模拟量表(VAS)评分。结果与T_(1)时点相比,S组与D组麻醉后各时点MAP、心率均有降低,差异均有统计学意义(均P<0.05)。2组各个时点MAP、心率组间比较差异均无统计学意义(均P>0.05)。2组患者肌松恢复时间、气管拔管时间比较差异均无统计学意义(均P>0.05)。S组拔管后即刻和拔管后2、6、12 h咽喉痛VAS评分均明显低于D组[3(2,4)分比4(4,5)分、2(1,2)分比5(5,6)分、2(1,2)分比4(4,5)分、1(0,1)分比2(1,2)分],差异均有统计学意义(均P<0.05)。2组患者围手术期均未出现误吸、喉痉挛、局部麻醉药中毒等不良反应。结论超声引导喉上神经阻滞与丁卡因表面麻醉均可以有效维持支撑喉镜下喉癌切除术血流动力学稳定,不影响苏醒时间,2组均无不良反应发生,但喉上神经阻滞组术后镇痛效果更佳。

Objective To compare the anesthetic effects between ultrasound-guided superior laryngeal nerve(SLN)block and tetracaine topical anesthesia in support laryngoscope for laryngeal carcinoma resection,and to provide clinical evidence and reference for further optimization of anesthesia scheme.Methods From June to September 2022,64 patients in Beijing Tongren Hospital,Capital Medical University,aged 40 to 70 years old,who scheduled for elective carbon dioxide laser resection of laryngeal carcinoma by laryngoscope under general anesthesia were enrolled.Patients were divided into two groups using the random number table method.Tetracaine surface anesthesia+general anesthesia intubation group(group D,n=32)received topical anesthesia with 1.5 ml 1%tetracaine at the root of the oropharynx,epiglottis and arytenoid twice(3 ml)compounded with general anesthesia intubation,while ultrasound-guided bilateral superior laryngeal nerve block+general anesthesia intubation group(group S,n=32)was ultrasound-guided bilateral SLN block(3 ml 0.2%ropivacaine)compounded with general anesthesia intubation.Mean arterial pressure(MAP)and heart rate(HR)were detected at the time of patients entering the operating room(T_(1)),immediately after intubation(T_(2)),suspensing laryngoscopy(T_(3)),3 min after suspensing laryngoscopy(T_(4)),immediately after extubation(T_(5)),and 3 min after extubation(T_(6)).The recovery profiles(including muscle relaxation recovery time and time to extubation)and adverse reactions were evaluated.The sore throat visual analogue scale(VAS)score at the moment and 2,6,12,24 h after extubation were recorded.Results Compared with T_(1),HR and MAP at T_(2)-T_(6)in the group D and group S were significantly decreased(all P<0.05).There were no significant differences in HR and MAP at each time point between the two groups(all P>0.05).There were no significant difference in the muscle relaxation recovery time and the time to extubation between the two groups(both P>0.05).Sore throat VAS score immediately after extubation and 2,6,12 h after extubation in group S were lower than those in group D[3(2,4)vs 4(4,5),2(1,2)vs 5(5,6),2(1,2)vs 4(4,5),1(0,1)vs 2(1,2)](all P<0.05).There were no adverse reactions such as aspiration,laryngeal spasm and local anesthetic poisoning in both groups during perioperative period.Conclusions Ultrasound-guided SLN block and topical anesthesia with tetracaine can effectively maintain the stability of intraoperative hemodynamics,without influencing patient′s recovery time.There were no adverse reactions in two groups.SLN block has better postoperative analgesic effect.