超声引导下喉上神经阻滞联合环甲膜穿刺对颅内动脉瘤介入栓塞患者应激反应的影响研究

Effect of ultrasound-guided superior laryngeal nerve block combined with cricothyroid membrane puncture on stress re-sponse in patients undergoing intracranial aneurysm embolization

目的探讨超声引导下喉上神经阻滞联合环甲膜穿刺对颅内动脉瘤介入栓塞患者应激反应的影响。方法选取2022年6月至2023年6月于浙江大学医学院附属金华医院行颅内动脉瘤介入栓塞术患者80例,均在全麻下进行手术。其中40例患者采用常规麻醉诱导和维持,为对照组;另40例患者采用超声引导下喉上神经内支阻滞联合环甲膜穿刺,为观察组。观察并比较两组患者麻醉诱导前(T_(0))、气管插管即刻(T_(1))、插管后5 min(T_(2))、手术结束时(T_(3))、拔管后即刻(T_(4))、拔管后5 min(T_(5))各时点平均动脉压(MAP)和心率(HR);测定并比较T_(0)、T_(1)、T_(2)各时点两组患者血浆肾上腺素(E)和去甲肾上腺素(NE)水平;比较两组患者术后苏醒时间、瑞芬太尼和丙泊酚用量。结果在T_(0)时,两组患者MAP、HR比较差异均无统计学意义(均P<0.05);在T_(1)、T_(4)、T_(5)时,观察组患者MAP、HR均低于对照组(均P<0.05);在T_(2)时,观察组患者MAP、HR均高于对照组(均P<0.05);在T_(3)时,两组患者MAP、HR比较差异均无统计学意义(均P>0.05)。在T_(0)时,两组患者E、NE水平比较差异均无统计学意义(均P>0.05);在T_(1)、T_(2)时,观察组患者E、NE水平均低于对照组(均P<0.05)。观察组患者术后苏醒时间、瑞芬太尼和丙泊酚用量均少于对照组(均P<0.05)。结论超声引导下喉上神经阻滞联合环甲膜穿刺能减轻颅内动脉瘤介入栓塞术患者在气管插管及拔管时的应激反应,维持血流动力学稳定,减少全麻药物用量,缩短术后苏醒时间,有利于避免因血流动力学剧烈波动而导致的颅内再次出血或动脉瘤破裂。

Objective To investigate the effect of ultrasound-guided superior laryngeal nerve block combined with cricothyroid membrane puncture on the stress response in patients undergoing interventional embolization of intracranial aneurysm.Methods A total of 80 patients who underwent interventional embolization of intracranial aneurysms in Jinhua Hospital from June 2022 to June 2023 were enrolled.General anesthesia was performed in all patients,among whom 40 patients were induced and maintained by conventional anesthesia(control group)and 40 patients were treated with ultrasound-guided superior laryngeal nerve internal branch block combined with cricothyroid membrane puncture(study group).The mean arterial pressure(MAP)and heart rate(HR)before anesthesia induction(T_(0)),immediately after endotracheal intubation(T_(1)),5 min after intubation(T_(2)),at the end of surgery(T_(3)),immediately after extubation(T_(4))and 5 min after extubation(T_(5))were observed and compared between the two groups.The plasma levels of epinephrine(E)and norepinephrine(NE)were measured and compared between the two groups at T_(0),T_(1)and T_(2).The postoperative recovery time,remifentanil and propofol dosage were compared between the two groups.Results There was no significant difference in MAP and HR between the two groups at T_(0)(both P>0.05).The MAP and HR at T_(1),T_(4)and T_(5)in the study group were lower than those of the control group(both P<0.05),while higher than those of the control group at T_(2)(both P<0.05),and there was no significant difference at T_(3)(both P>0.05).There was no significant difference in E and NE levels at T_(0)between the two groups(both P>0.05).E and NE levels at T_(1)and T_(2),in the study group were lower than those in the control group(both P<0.05).The postoperative recovery time was shorter,remifentanil and propofol dosages were lower in the study group than those in the control group(both P<0.05).Conclusion Ultrasound-guided superior laryngeal nerve block combined with cricothyroid membrane puncture can alleviate the stress response of endotracheal intubation and extubation,maintain hemodynamic stability,reduce the dosage of general anesthesia,shorten the postoperative recovery time,and reduce hemodynamic fluctuations in patients undergoing interventional embolization of intracranial aneurysm.