超声引导喉上神经阻滞联合环甲膜穿刺在颈髓损伤患者经鼻清醒气管插管中的应用

目的 探讨超声引导喉上神经阻滞联合环甲膜穿刺在颈髓损伤患者经鼻清醒气管插管中的应用。 方法 选取80例拟行颈椎减压植骨内固定术需要经鼻清醒气管插管全身麻醉患者，随机分为对照组和超声组，每组40例。对照组在体表定位下行喉上神经阻滞联合环甲膜穿刺后经鼻气管插管，超声组在超声引导下行喉上神经阻滞联合环甲膜穿刺后经鼻气管插管。记录入室后（T0）、气管导管进入咽喉（T1）、气管导管进入声门即刻（T2）、插管成功后5 min（T3）的平均动脉压(mean arterial pressure,MAP)和心率(heart rate,HR)，并记录插管成功情况、插管时间及记录患者术后耐管程度。 结果 对照组T1 、T2 、T3 时的MAP和HR均明显大于T0（P＜0.05）。超声组T1 、T2 、T3 的MAP和HR与T0比较，差异无统计学意义（P＞0.05）。超声组呛咳发生率明显低于对照组（P＜0.05）。超声组患者术后耐管程度高于对照组（P＜0.05）。 结论 超声引导喉上神经阻滞联合环甲膜穿刺能够满足经鼻清醒气管插管的需要，患者血流动力学稳定，不良反应少。

Application of ultrasound-guided superior laryngeal nerve block combined with cricothyroid membrane puncture for awake tracheal intubation in patients with cervical spinal cord inj ury

Objective To explore the efficacy of the ultrasound-guided superior laryngeal nerve block combined with cricothyroid membrane puncture for awake tracheal intubation in patients with cervical spinal cord injury. Methods Eighty patients with cervical spinal cord injury scheduled for selective surgery under awake tracheal intubation were enrolled .The patients were randomly divided into two groups(n=40): control group and ultrasound group.Control group received superior laryngeal nerve block combined with cricothyroid membrane puncture using the acupoint-located method by anatomical landmark. Ultrasound group received ultrasound-guided superior laryngeal nerve block combined with cricothyroid membrane puncture.The mean arterial pressure(MAP) and heart rate(HR) were recorded at the time of burglary (T0 ),before the endotracheal tube into the nasopharynx (T1 ), endotracheal tube into the glottis immediately(T2 ), 5 min after intubation (T3 ). The time of intubation, the success rate of intubation were recorded.The incidence of complications were also recorded,including cough,nausea and vomiting,and the tolerance degree of tube postoperative. Results The mean arterial pressure and heart rate of T1, T2 and T3 in the control group were significantly higher than T0(P＜0.05). There was no significant difference in the mean arterial pressure and heart rate of T1, T2 and T3 between two groups(P＞0.05). The incidence of choking in the ultrasound group was significantly lower than that in the control group(P＜0.05). The degree of tube resistance in the ultrasonic group was higher than that in the control group(P＜0.05). Conclusion Ultrasound-guided superior laryngeal nerve block combined with cricothyroid membrane puncture can meet the needs of conscious tracheal intubation through nose, with stable hemodynamics and less adverse reactions.