超声引导喉上神经阻滞结合环甲膜穿刺在肥胖症患者气管插管中的应用

鲁利峰 孟海兵 来伟 程乐 范翌晗 吴林纳

【摘要】 目的：探究超聲引导下喉上神经阻滞结合环甲膜穿刺在肥胖症患者中的应用价值。方法：以本院2019年9月-2021年9月择期行气管插管全身麻醉手术且合并肥胖症的60例患者作为研究对象，根据简单随机化法将其划分为两组，对照组30例（行传统神经阻滞结合环甲膜穿刺方法治疗），观察组30例（行超声引导喉上神经阻滞配合环甲膜穿刺方法治疗）。比较两组的麻醉优良情况、耐受性、并发症发生情况。结果：观察组麻醉优良率为96.67%，明显高于对照组的66.67%，差异有统计学意义（P<0.05）。观察组气管插管时耐性、管插管后即刻耐受性的评分均较对照组高（P<0.05）。观察组不良反应发生率为6.67%，明显低于对照组30.00%，差异有统计学意义（P<0.05）。结论：超声引导下喉上神经阻滞结合环甲膜穿刺对肥胖症患者麻醉效果较好，提高患者插管耐受性，减少咽喉部并发症。

【关键词】 超声引导 喉上神经阻滞 环甲膜穿刺 肥胖症 耐受性

Application of Ultrasound-guided Superior Laryngeal Nerve Block Combined with Cricothyroid Membrane Puncture in Endotracheal Intubation in Obese Patients/LU Lifeng， MENG Haibing， LAI Wei， CHENG Le， FAN Yihan， WU Linna. //Medical Innovation of China， 2021， 18（35）： -146

[Abstract] Objective： To explore the value of ultrasound-guided superior laryngeal nerve block combined with cricothyroid membrane puncture in patients with obesity. Method： A total of 60 patients undergoing elective endotracheal intubation under general anesthesia and complicated with obesity in our hospital from September 2019 to September 2021 were selected as the research subjects， they were divided into two groups according to simple randomization method， and 30 patients in the control group were treated with traditional nerve block combined with cyclothyroid membrane puncture， 30 patients in the observation group were treated with ultrasound-guided upper laryngeal nerve block combined with cricothyroid membrane puncture. The excellent status， tolerance and complications of anesthesia were compared between the two groups. Result： The excellent and good rate of anesthesia in the observation group was 96.67%， which was significantly higher than 66.67% in the control group， the difference was statistically significant （P<0.05）. The scores of tolerance and immediate tolerance after endotracheal intubation in the observation group were higher than those in the control group （P<0.05）. The incidence of adverse reactions in the observation group was 6.67%， significantly lower than 30.00% in the control group， the difference was statistically significant （P<0.05）. Conclusion： Ultrasound-guided superior laryngeal nerve block combined with cricothyroid membrane puncture has a good anesthetic effect on obese patients， improves intubation tolerance and reduces throat complications.

[Key words] Ultrasound guidance Superior laryngeal nerve block Cricothyroid membrane puncture Obesity Tolerance

First-author’s address： 908 Hospital of PLA Joint Logistics Support Force， Nanchang 330000， China

doi：10.3969/j.issn.1674-4985.2021.35.035

合并肥胖疾病对患者危害大，一旦患病，常需氣管插管。患者气管插管全身麻醉是手术中最为常见的一种麻醉方式，但不能排除困难气道的发生，困难气道会导致气管插管不成功，从而使临床治疗工作开展受阻[1-2]。当前，临床多使用超声引导下进行喉上神经阻滞，改善气管插管造成的患者疼痛及躯体不舒适，使气管插管更可行，而该手术对操作者具有较高要求，若操作不当反而会给患者带来伤害，所以寻找安全、有效的插管方式尤为重要[3-4]。……