[摘要] 目的 探讨超声引导双侧喉上神经阻滞在老年纤维支气管镜检查术中的应用价值。方法 随机将40例拟行纤维支气管镜检查术老年患者分为2组，每组20例。Ⅰ组行超声引导下双侧喉上神经阻滞，Ⅱ组纤维支气管镜通过声门前后经纤维支气管镜侧孔各注入2%利多卡因3ml、5ml。2组患者在行纤维支气管镜前均先用利多卡因行舌根部喷雾表面麻醉。记录患者入室时（T1）、纤维支气管镜至咽部（T2）、入声门即刻(T3)、操作1min(T4)、操作5min(T5)时间点心率、血压、脉氧饱和度；记录喉上神经阻滞一次成功率、呛咳程度、患者耐受程度、相关并发症及操作者满意度等。结果 2组各时间点脉氧饱和度均高于94%。Ⅱ组T2、T3时点MAP、HR均较T1明显升高和增快（P<0.05）。两组T2、T3时点比较，Ⅱ组患者不同时点呛咳程度、纤维支气管镜耐受程度中3、4级病例数明显大于Ⅰ组（P<0.05）。操作者满意度Ⅰ组明显优于Ⅱ组（P<0.05）。结论 超声引导喉上神经阻滞能更好地抑制患者声门反射、减少心血管应激反应，可为老年患者更为舒适的完成纤维支气管镜检查提供满意条件。
[关键词] 超声引导 喉上神经阻滞 纤维支气管镜
THE APPLICATION OF ULTRASONOGRAPHY-GUIDED SUPERIOR LARYNGEAL NERVE BLOCK IN OLD PATIENTS BRONCHOFIBROSCOPY
YANG Fang,FENG Xueliang, WANG Guohui,GENG Zhilong
(Department of Anesthesiology,Lanzhou General Hospital ，Lanzhou military command,Lanzhou,Gansu Province, 730050)
[Abstract] : Objective To study the value of ultrasonography-guided superior laryngeal nerve block(SLNB) in old patients bronchofibroscopy.Methods: Fourty old patients with bronchofibroscopy were randomly divided into two groups. The two groups were sprayed anesthesia the oropharyngeal.The group Ⅰ received ultrasonography-guided superior laryngeal nerve block.The group Ⅱ ,After brochofibroscopy entered the glottis, performed trachea local anesthesia by 5ml lidocaine from the lateral aperture of brochofibroscopy.The mean arterial pressure(MAP),heart rate(HR)and pulse oxygen saturation(SpO2) were recorded at the ertry of operating room (T1),bronchofibroscope enter the throat(T2),bronchofibroscope enter the glottis(T3),procedure in trachea 1 minutes(T4) and 5minutes(T5). The rate of successful SLNB,the degree of bucking ,tolerance to brochofibroscope,presence or absences of complication and operator satisfaction were Recorded.Results The SpO2 >94% in the two group.In Group Ⅱ,MAP and HR were higher and faster then T1(P<0.05) at the point of T2 and T3.Compared to Group Ⅱ, Tolerance of the patients to brochofibroscopy and bucking degree in grade 3 and 4 were significantly higher at T2 and T3 in the group Ⅰ（P<0.05）。The total satisfacation of operator were Ⅰsignificantly higher in group Ⅰ.Conclusion The ultrasonography-guided superior laryngeal nerve block can inhibit the patients throat reflex,depress cardiovascular stress reaction,and provides satisfactory conditions for elderly patients to be more comfortable with fiberoptic bronchoscopy.
[Key words] Ultrasonography; Superior laryngeal nerve block ;Brochofibroscopy.
纤维支气管镜(纤支镜)已普遍应用于门诊呼吸系统疾病的诊断与治疗。老年患者通常伴发呼吸系统及心血管系统疾病等，患者在清醒状态下行纤支镜检查时声门反射活跃，致纤支镜通过声门较困难。纤支镜入气管时强烈刺激所引起的屏气、抬头、呛咳及心率、血压骤增不仅给患者带来巨大的风险，同时也给操作者的操作带来很大的困难。因而麻醉方式的选择与该项检查能否顺利进行直接相关[1]。目前所用的辅助镇静药或镇痛药联合表面麻醉虽能提供较好的镇静及麻醉，但对老年患者易导致呼吸循环抑制。因而如何对行纤支镜检查患者实施舒适且对机体影响小的麻醉技术是目前急需解决的问题。超声引导喉上神经阻滞用于纤支镜检查的相关研究报道在国内甚少，本研究旨在探讨超声引导双侧喉上神经阻滞在老年患者纤支镜检查术中的可行性及安全性。
1 资料与方法
1.1 一般资料 该研究通过医院伦理委员会批准，患者或家属均签署知情同意书。选取40例行纤支镜检查老年患者，其中男28例，女12例，年龄65～80岁，平均72岁，体重42～81Kg，术前ASAⅠ～Ⅱ级。排除重要脏器功能不全及严重心血管疾病患者，按随机数字表法将患者分为研究组（Ⅰ组：超声引导双侧喉上神经阻滞）及对照组（Ⅱ组），每组20例。纤维支气管镜检查及超声引导喉上神经阻滞均各由同一操作者完成。
1.2 方法 所有患者均先行舌根、口咽部利多卡因喷雾，取仰卧位，进行心电监护，鼻导管吸氧，监测脉搏氧饱和度和无创血压。纤支镜下段涂无菌石蜡油，为减少鼻腔刺激，两侧鼻腔滴1-2ml利多卡因。Ⅰ组行超声引导下双侧喉上神经阻滞，5分钟后行纤支镜检查，待纤支镜前端通过声门后喷局麻药。Ⅱ组在行纤支镜检查时经纤支镜侧孔向咽喉部声门及声门下逐个喷局麻药。
作者：杨芳 冯学亮 王国慧 耿智隆（兰州军区兰州总医院麻醉科 甘肃 兰州 730050）