不同浓度罗哌卡因超声引导下喉上神经阻滞 对支撑喉镜下会厌囊肿切除术的影响

The effect of ultrasound-guided superior laryngeal nerve block with different concentration of ropivacaine on epiglottic cyst removal under suspension laryngoscope

摘要:

目的 观察在超声引导下不同浓度的盐酸罗哌卡因喉上神经阻滞对会厌囊肿切除术患者的影响。 方法 选取2019 年9 月—2019 年11 月南京医科大学附属淮安第一医院收治的行支撑喉镜下会厌囊肿切除术 的会厌囊肿患者60 例。随机分为对照组、正常浓度组和低浓度组。对照组实施静脉全身麻醉（以下简称全 麻），正常浓度组采用盐酸罗哌卡因（0.5%）在超声引导下行双侧喉上神经阻滞联合静脉全麻，低浓度组采用 低浓度盐酸罗哌卡因（0.25%）在超声引导下行双侧喉上神经阻滞联合静脉全麻。结果 正常浓度组、低浓 度组置入喉镜前（T0）、脑电双频普指数（BIS）值在40 ～ 60 时（T2）的丙泊酚泵注速率、瑞芬太尼泵注速 率较对照组低（P <0.05）。正常浓度组、低浓度组T0、置入喉镜即刻（T1）的心率（HR）、平均脉动压（MAP） 和BIS 最大波动值较对照组低（P <0.05）。正常浓度组、低浓度组拔管后即刻、拔管后6 h 的VAS 评分较 对照组低（P <0.05）。低浓度组拔管后有并发症的患者数较正常浓度组低，满意度较正常浓度组、对照组高 （P <0.05）。结论 0.25% 罗哌卡因神经阻滞能更好地保持术中血流动力学平稳，有效减轻会厌囊肿患者术后 疼痛，同时减轻术后并发症，实现患者的舒适化医疗和快速康复。

Abstract:

Objective To observe the impact of different concentration of ropivacaine on patients undergoing epiglottic cyst removal. Methods A total of 60 patients who received epiglottic cyst removal in our hospital from September 2019 to November 2019 were included and randomly divided into control group (Group A), normal-dose group (Group B) and low-dose group (Group C). Group A received general anesthesia, Group B received ultrasoundguided bilateral superior laryngeal nerve block with 0.5% ropivacaine hydrochloride combined with general anesthesia, while Group C received general anesthesia and was administrated with 0.25% ropivacaine hydrochloride to achieve ultrasound-guided bilateral superior laryngeal nerve block. Results The demographic characteristics of the three groups showed no significant difference (P > 0.05). The infusion rates of propofol and remifentanil before laryngoscope placement (T0) and when the BIS value was 40 to 60 (T2) in Group B and C were lower than those in Group A (P < 0.05). The HR, MAP and BIS maximum fluctuation at T0 and the moment of laryngoscope placement (T1) in Group B and C were lower than those in Group A (P < 0.05). The VAS scores at the moment and 6 h after extubation in Group B and C were significantly lower than those of Group A (P < 0.05). The incidence of dyspnea and dysphagia after extubation in Group C was lower than those in Group B (P < 0.05), while the satisfaction of Group C was higher than that in Group B and A (P < 0.05). Conclusions To achieve the superior laryngeal nerve block with 0.25% ropivacaine could better keep hemodynamic stablity, effectively relieve postoperative pain in patients with epiglottic cyst, reduce the incidence of complications, and achieve comfortable medical treatment and rapid recovery.