喉上神经阻滞联合气管内表面麻醉在老年高血压患者气管插管中的应用分析

Application of superior laryngeal nerve block combined with intratracheal superficial anesthesia in tracheal intubation in elderly patients with hypertension

目的探究喉上神经阻滞联合气管内表面麻醉在老年高血压患者全身麻醉气管插管中应用效果,进一步明确老年高血压其麻醉方案优化的必要性,以期为患者临床麻醉提供新的方法,提高手术治疗效果。方法选取2021年3月—2023年3月于遂宁市中心医院就诊的172例老年高血压患者的病例资料作为观察对象,采用简单随机化法将患者分为观察组与对照组,每组86例。对照组采用全麻诱导插管,观察组采用喉上神经阻滞联合气管内表面麻醉。比较2组插管情况(一次性气管插管成功率、总插管成功率、平均插管时间、呛咳发生率),对比2组插管前、插管时、插管后(T1、T2、T3)的血流动力学[心率(HR)、血压(SBP、DBP)及血氧饱和度(SpO_(2))]指标值的变化,T1、T3时2组血清[肾上腺素(E)、去甲肾上腺素(NE)及皮质醇(Cor)]水平,记录2组插管期间不良事件的发生情况。手术结束后对患者的苏醒情况进行记录。结果观察组一次性插管成功率(97.67%)高于对照组(89.53%),平均插管时间[(34.52±5.19)s]低于对照组[(40.76±5.49)s](均P<0.05),而2组总插管成功率、呛咳发生率差异无统计学意义(P>0.05)。T2、T3时观察组HR、SBP、DBP值低于对照组,SpO_(2)值高于对照组(均P<0.05)。T3时观察组E、NE水平[(35.58±6.26)kg/m^(2)、(158.76±14.36)g/L]低于对照组[(47.30±9.22)kg/m^(2)、(167.74±14.46)g/L](均P<0.05)。观察组肌肉松弛恢复时间、PAED评分、拔管时间[(8.16±2.35)min、(8.67±1.32)分、(10.56±3.30)min]均少/低于对照组[(9.79±3.05)min、(10.40±1.38)分、(12.67±3.20)min](均P<0.05)。结论喉上神经阻滞联合气管内表面麻醉降低老年高血压患者插管反应的效果显著,有利于维持患者血流动力学稳定,具有一定临床应用价值。

Objective To explore the application effects of superior laryngeal nerve block combined with intratracheal superficial anesthesia in tracheal intubation of elderly patients with hypertension,and further clarify the necessity of anesthesia regimen optimization for elderly patients with hypertension,so as to provide a new method for clinical anesthesia and improve the effect of surgical treatment.Methods 172 elderly hypertensive patients treated in Central Hospital of Suining City from March 2021 to March 2023 were selected as the observation subjects.They were divided into observation group and control group by simple randomization method,with 86 cases in each group.The control group received general anesthesia induced intubation,while the observation group received superior laryngeal nerve block combined with intratracheal superficial anesthesia.The intubation results(one-time success rate of tracheal intubation,total success rate of intubation,average intubation time,incidence of choking cough)of the two groups were compared.The changes of hemodynamic indexes[heart rate(HR),blood pressure(SBP,DBP)and saturation of percutaneous oxygen(SpO_(2))]before,during and after intubation(T1,T2,T3)in the two groups were compared.The levels of serum adrenaline(E),norepinephrine(NE),and cortisol(Cor)before intubation(T1)and after successful intubation(T3)in the two groups were compared.The occurrence of adverse events during intubation was recorded in both groups.The recovery status of patients was recorded after the end of surgery.Results The success rate of one-time intubation in the observation group(97.67%)was higher than that in the control group(89.53%),and the average intubation time[(34.52±5.19)s]was shorter than that in the control group[(40.76±5.49)s](all P<0.05).There was no significant difference in the total success rate of intubation and the incidence of choking cough between the two groups(P>0.05).At T2 and T3,the HR,SBP and DBP of the observation group were lower than those of the control group,while the SpO_(2)was higher than that of control group(all P<0.05).At T3,the levels of E and NE of the observation group[(35.58±6.26)kg/m^(2),(158.76±14.36)g/L]were lower than those of the control group[(47.30±9.22)kg/m^(2),(167.74±14.46)g/L](all P<0.05).The recovery time of muscle relaxation,extubation time and PAED score of the observation group[(8.16±2.35)min,(10.56±3.30)min,(8.67±1.32)points]were shorter or lower than those of the control group[(9.79±3.05)min,(12.67±3.20)min,(10.40±1.38)points](P<0.05).Conclusion The combination of superior laryngeal nerve block and intratracheal superficial anesthesia can significantly reduce intubation response in elderly patients with hypertension,which is beneficial to maintaining hemodynamic stability of patients,and has certain clinical application value.