国际麻醉学与复苏杂志   2020, Issue (2): 11-11
    
超声引导下喉上神经内支阻滞治疗全身麻醉拔管后咽喉疼痛的临床研究
王美容, 欧阳惠碧, 林逸诚, 李志鹏, 何妹仪, 柳垂亮1()
1.佛山市禅城区中心医院
A clinical study of ultrasound‑guided internal branch of superior laryngeal nerve block to treat postoperative sore throat after extubation under general anesthesia
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摘要：

目的 研究超声引导下双侧喉上神经内支（internal branch of superior laryngeal nerve, ibSLN）阻滞对全身麻醉拔管术后咽喉疼痛（postoperative sore throat, POST）的治疗效果。 方法 选择全身麻醉拔管后出现中重度咽喉疼痛患者60例作为研究对象，ASA分级Ⅰ、Ⅱ级，年龄18岁～45岁，按随机数字表法分为利多卡因+布地奈德雾化吸入组（L组）及喉上神经内支阻滞组（S组），每组30例。记录两组治疗前即刻（T0）、治疗后10 min（T1）、治疗后30 min（T2）、治疗后1 h（T3）、治疗后2 h（T4）、治疗后4 h（T5）、治疗后8 h（T6）、治疗后24 h（T7）POST的VAS评分及镇痛显著有效率，记录T0～T7时MAP、心率及SpO2，观察并记录两组饮水呛咳、反流误吸、声音嘶哑（声嘶）、呼吸困难等不良反应发生情况及患者对治疗满意度评分。 结果 S组T0～T6时咽喉疼痛VAS评分低于L组（P<0.05），镇痛显著有效率S组在T1～T6时高于L组（P<0.05）；S组于T1～T4时心率低于L组（P<0.05），MAP于T1～T3时低于L组（P<0.05）；满意度评分S组高于L组（P<0.05）；两组患者均未发生饮水呛咳、反流误吸、声嘶、呼吸困难等。 结论 超声引导下双侧ibSLN阻滞可有效治疗全身麻醉拔管后POST，镇痛效果明显高于传统的激素复合局部麻醉药雾化吸入，为全身麻醉拔管后POST提供了较好的治疗方法。
关键词： 超声引导； 喉上神经； 神经阻滞麻醉； 术后咽喉疼痛； 麻醉，全身
Abstract:

Objective To investigate the efficacy of ultrasound‑guided internal branch of superior laryngeal nerve (ibSLN) block to treat postoperative sore throat (POST) after extubation under general anesthesia. Methods Sixty patients, aged from 18 to 45 years old, American Society of Anesthesiologist (ASA) Ⅰ or Ⅱ who suffered from moderate to severe postoperative sore throat after extubation under general anesthesia were selected. They were divided into two groups according to the random number table method (n=30): a lidocaine combined with budesonide aerosol inhalation group (group L) and an iBSLN block group (group S). The Visual Analogue Scale (VAS) scores and the significant analgesic efficiency rate of POST were recorded in two groups immediately before treatment (T0), 10 min after treatment (T1), 30 min after treatment (T2), 1 h after treatment (T3), 2 h after treatment (T4), 4 h after treatment (T5), 8 h after treatment (T6), and 24 h after treatment (T7). The mean arterial pressure (MAP), heart rate, and pulse oxygen saturation (SpO2) were also recorded from T0 to T7. Adverse reactions such as chocking on water, regurgitation and aspiration, hoarseness and dyspnea were observed in the two groups, while the score of patient satisfaction towards treatment was evaluated. Results The VAS score of POST in group S was lower than that in group L from T0 to T6 (P<0.05). The significant analgesic efficiency rate of POST in group S was significantly higher than that in group L from T1 to T6 (P<0.05). Compared with group L, heart rate in group S reduced from T1 to T4 (P<0.05), while MAP decreased from T1 to T3 (P<0.05). The satisfaction score of group S was higher than that of group L (P<0.05). No chocking on water, regurgitation and aspiration, hoarseness, and dyspnea was found in the two groups. Conclusions Ultrasound‑guided ibSLN block can effectively treat POST after extubation under general anesthesia, with remarkably improved analgesic effects in comparison with traditional methods where hormone combined with local anesthetic aerosol are inhaled. It provides a good approach to treat POST after extubation under general anesthesia.
Key words: Ultrasound‑guided; Superior laryngeal nerve; Nerve blocking anesthesia; Postoperative sore throat; Anesthesia, general