舌咽神经、喉上神经阻滞联合气管黏膜表面麻醉抑制气管插管反应的效果观察

目的 观察舌咽神经、喉上神经阻滞联合气管黏膜表面麻醉对气管插管反应的抑制作用.方法 选取ICU清醒至浅昏迷的具有气道保护反应且需要气管插管的40例患者,将其随机分为两组,每组各20例.在插管前给予A组患者咪唑安定5 mg适当镇静,尔后行舌咽神经、喉上神经阻滞,环甲膜穿刺,气管内表面麻醉,5～10 min后行经口气管插管.常规给予B组患者丙泊酚2 mg/kg,司可林1.5 mg/kg,肌松后插管.记录插管前、插管后1 min、15 min、45 min的血压、脉搏、插管反应（呛咳、作呕、喉痉挛）、插管时间、插管次数、副反应.结果 A组患者的血压、心率变化较小.B组则较规律地出现插管后血压先上升后下降的变化.A组插管时间长于B组,A组患者咬肌不如B组松弛.10 min后83.5％的B组患者出现明显呛咳,需要后续镇静.34％的A组患者有呛咳反应,给予镇静.45 min时,A组患者没有出现局麻药失效后的气道高敏反应.结论 行舌咽神经、喉上神经联合气管黏膜表面麻醉可以有效地抑制气管插管反应,较静脉快速给药患者相对安全.

Effect Observation of Glossopharyngeal Nerve,Laryngeal Nerve Block on the Joint Surface of Endotracheal Anesthesia on Tracheal Intubation Response Inhibition

Objective To observe block glossopharyngeal nerve, laryngeal nerve block on the joint surface of endotracheal anesthesia on tracheal intubation response inhibition. Methods Selecting 40 cases of ICU awake to light coma patients with airway protective reaction and endotracheal intubation, and randomly dividing them into two groups. As the observation group, group A before intubation were given imidazole stability and 5 rag appropriate calm, then glossopharyngeal nerve, laryngeal nerve block, cricothyroid membrane puncture, endo- tracheal surface anesthesia and oral trachea cannula after 5 -10min. Group B as control group were given propofol 2 mg/kg, succinyl cho- line 1.5 mg/kg and muscle relaxant after intubation. Records were done on intubation blood pressure, pulse, intubation response （ choke to cough, disgusting, laryngospasm）, intubation time, number of intubation and side effects 1 minutes, 15 minutes, 45 minutes before and af- ter intubation. Results Patients in group A had small changes in blood pressure and heart rate changes. Group B was the law of a drop in blood pressure to rise after intubation. Group A had intubation time longer than group B. 83.5% in group B had significant choking cough in about 10 minutes, and needed follow - up calm. 34% group A didn＇t have choking cough response. Conclusion Glossopharyngeal nerve, joint cricothyroid membrane puncture surface anesthesia on laryngeal nerve can effectively inhibit endotracheal intubation response, which is safer than intravenous dosing in patients with relatively quickly.