文章摘要
超声引导下喉上神经阻滞用于支撑喉镜下声带息肉摘除术中的效果
Efficacy of ultrasonograpy-guided bilateral superior laryngeal nerve block for polypectomy of vocal cord by laryngoscope
  
DOI：10.12089/jca.2018.05.009
中文关键词: 超声引导  喉上神经阻滞  支撑喉镜  声带息肉摘除术
英文关键词: Ultrasonograpy-guided  Bilateral superior laryngeal nerve block  Laryngoscope  Polypectomy of vocal cord
基金项目:南京市医学科技发展项目（YKK16141）
作者单位E-mail
沈妍 210006,南京医科大学附属南京医院,南京市第一医院麻醉科  
张勇 210006,南京医科大学附属南京医院,南京市第一医院麻醉科  
赵倩 210006,南京医科大学附属南京医院,南京市第一医院麻醉科  
方兆晶 210006,南京医科大学附属南京医院,南京市第一医院麻醉科  
王晓亮 210006,南京医科大学附属南京医院,南京市第一医院麻醉科 wxl145381@163.com 
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中文摘要:
      目的 探讨超声引导下不同浓度利多卡因喉上神经阻滞在支撑喉镜下声带息肉摘除术中的临床效果。方法 择期行支撑喉镜下声带息肉摘除术患者60例,性别不限，年龄18～65岁，ASA Ⅰ或Ⅱ, 随机分为三组, 每组20例。A组: 超声引导下2％利多卡因双侧喉上神经阻滞联合静脉全麻；B组：超声引导下1％利多卡因双侧喉上神经阻滞联合静脉全麻；C组：传统定位2％利多卡因双侧喉上神经阻滞联合静脉全麻。记录入室时(T0)、气管插管进入声门即刻(T1)、支撑喉镜置入成功即刻(T2)、支撑喉镜置入成功后5 min(T3)、拔管即刻(T4)、拔管后5 min(T5)的HR、MAP、SpO2及血浆NE浓度；记录拔管时间和拔管后2 h出现喉上神经阻滞并发症(吞咽困难、呼吸困难)的情况。结果 与T0时比较, T1～T5时三组HR明显增快,MAP明显升高(P＜0.05), 但A、B组HR明显慢于C组，MAP明显低于C组(P＜0.05)。与C组比较, T1～T5时A、B组NE浓度明显降低(P＜0.05)。A、B组拔管时间明显短于C组(P＜0.05)。结论 超声引导下1％利多卡因双侧喉上神经阻滞效果确切, 可减少支撑喉镜术中应激反应, 缩短拔管时间, 减少患者术后不适。
英文摘要:
      Ojective To investigate the effect of ultrasonograpy (US)-guided bilateral superior laryngeal nerve (SLN) block by different concentrations of lidocaine combined with intravenous anesthesia for polypectomy of vocal cord by laryngoscope. Methods Sixty patients, aged 18-65 years, ASA physical status Ⅰ or Ⅱ, scheduled for elective polypectomy of vocal cord by laryngoscope were divided into 3 groups (n=20 each) using a random number table: US-guided bilateral SLN block by 2％ lidocaine (group A), S-guided bilateral SLN block by 1％ lidocaine (group B), and traditional SLN block by 2％ lidocaine (group C). HR, MAP, SpO2 and plasma concentration of NE were detected at the time of patients entering the operating room (T0), immediately after intubation(T1), suspensing laryngoscopy (T2), 5 min after suspensing laryngoscopy (T3), immediately after extubation(T4), 5 min after extubation(T5). Extubation time and side effects such as dysphagia and dyspnea in two hours after extubation were recorded as well. Results HR and MAP in the three groups at T1-T5 were increased compared to T0 (P＜0.05). Compared with group C, HR and MAP in groups A and B were decreased at T1-T5 (P＜0.05). Plasma concentration of NE of groups A and B was more significantly decreased than group C (P＜0.05), and extubation time of groups A and B was less than that of group C (P＜0.05). Conclusion US-guided bilateral SLN block by 1％ lidocaine has definite effect and better comfort level, with stable haemodynamics and less extubation time.
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