超声引导甲状舌骨膜与甲状舌骨肌间隙阻滞用于支气管镜检查的效果观察

Efficacy of ultrasound-guided the thyrohyoid muscle and the thyrohyoid membrane bilaterally space block for awake fiberoptic bronchoscopy

摘要:

目的 评价超声引导甲状舌骨膜与甲状舌骨肌间隙阻滞在支气管镜检查中的应用效果。方法 选取择期行支气管镜检查的患者60例，采用随机数表法分为超声引导甲状舌骨膜与甲状舌骨肌间隙阻滞组（U组，n = 30）和传统方法组（C组，n = 30），均于术前雾化吸入2%利多卡因15 min，并行环甲膜穿刺表面麻醉。年龄65～80岁，体重45～80 kg，性别不限，美国麻醉医师协会（ASA）分级Ⅰ级或Ⅱ级。U组于超声引导下行甲状舌骨膜与甲状舌骨肌间隙阻滞，将1%利多卡因3 mL注入甲状舌骨膜与甲状舌骨肌之间的筋膜间隙。记录入室时（T₀）、纤维支气管镜进口腔前（T₁）、纤维支气管镜进声门即刻（T₂）和纤维支气管镜进入气管后5 min（T₃）的平均动脉压（MAP）、心率（HR）、经皮动脉血氧饱和度（SpO₂）和Ramsay镇静评分，并记录患者的舒适度情况。结果 与C组比较，U组T₂时点MAP明显降低，HR减慢（P < 0.05），检查过程中，舒适度评分明显降低，补救例数明显减少，且恶心呕吐和呛咳的发生率明显降低（P < 0.05）。结论 超声引导甲状舌骨膜与甲状舌骨肌间隙阻滞可有效阻滞喉上神经，提高纤维支气管镜检查表面麻醉效果，减轻检查操作时导致的应激反应，术后会发生声音嘶哑，但不影响患者舒适度的体验。

Abstract:

Objective To evaluate the effect of ultrasound-guided bilateral the thyrohyoid muscle and thyrohyoid membrane space block for awake fiberoptic bronchoscopy.Methods 60 patients scheduled for elective awake fiberoptic bronchoscopy were randomly selected and divided into two groups using a random number table: ultrasound-guided the thyrohyoid muscle and the thyrohyoid membrane bilaterally space group (group U, n = 30) and traditional group (group C, n = 30), nebulized 2% lidocaine was inhaled and cricothyroid membrane injection was adopted in both group for topical anesthesia before operation. Aged 65 ~ 80 years, weighed 45 ~ 80 kg, American Society of Anesthesiology (ASA) grade Ⅰ or Ⅱ. In group U, the probe was placed in a paramedian sagittal position to locate the hyoid bone and thyroid cartilage, and 1% lidocaine 3 mL was injected into the space between the thyrohyoid muscle and the thyrohyoid membrane bilaterally. Mean arterial pressure (MAP) , heart rate (HR) and percutaneous arterial oxygen saturation (SpO₂) were recorded at the time of entering the room (T₀), before fiberoptic bronchoscopy entering the mouth (T₁), immediately after entering the glottis (T₂), and 5 min after entering the trachea (T₃). Ramsay sedation scores and patients’ comfort score were recorded.Results Compared with group C, MAP and HR decreased significantly at T₂ in group U (P < 0.05), comfort score descreased significantly, the number of remedial cases decreased significantly, and the incidence of nausea, vomiting, cough and physical activity decreased significantly in group U (P < 0.05).Conclusion Ultrasound-guided the thyrohyoid muscle and the thyrohyoid membrane bilaterally space block can improve topical anesthesia efficacy of fiberoptic bronchoscopy, reduce the stress response of examination operation, improve the comfort of patients with seldom adverse reactions, meanwhile the incidence of postoperative hoarseness did not affect the patient's comfort.