喉上神经阻滞联合利多卡因雾化吸入在支气管镜诊疗中的应用

摘要 目的：比较喉上神经阻滞联合利多卡因雾化吸入法与利多卡因含漱法用于支气管镜诊疗的治疗效果及安全性。方法：选取新疆医科大学第三临床医学院首次行气管镜诊疗的患者120例,随机分为4组。利多卡因含漱组：2%盐酸利多卡因注射液喉部含漱;利多卡因雾化吸入组：2%利多卡因注射液雾化吸入;喉上神经阻滞组：B超定位下以1%利多卡因阻滞双侧喉上神经内支。联合组：联合使用喉上神经内支阻滞与利多卡因雾化吸入。记录各组在诊疗中咳嗽、憋喘、体动次数及操作期间患者血压、心率、血氧饱和度等情况,以及诊疗后疼痛视觉模拟评分（VAS评分）。结果：利多卡因含漱组呛咳、憋喘发生率最高,显著高于其余各组（P＜0.01）;联合组呛咳、憋喘发生率最低,显著低于其余各组（P＜0.05）。利多卡因含漱组患者血压、心率在支气管镜进入声门时及气管内诊疗时显著高于各组（P＜0.01）;联合组患者的平均动脉压及心率在支气管镜进入声门时低于（P＜0.05）其余两组。各组SpO₂均高于90%,其中利多卡因含漱组患者最低（P＜0.01）,联合组最高（P＜0.05）。各组疼痛VAS评分多低于3分,但在各组之间均有差异（P＜0.05）,其中联合组最低（P＜0.05）。结论：喉上神经内支阻滞联合利多卡因雾化吸入用于支气管镜诊疗可以有效地抑制气管应激反应,减少疼痛刺激,有利于维持诊疗期间的血流动力学稳定,其安全性和有效性优于利多卡因含漱法及单独采用利多卡因雾化吸入或喉上神经阻滞法。支气管镜诊疗过程中患者多为轻度疼痛,咽喉部不适引起的呛咳、憋喘才是患者难以耐受的原因。

Application of Ultrasound-guided Superior Laryngeal Nerve Block Combined with Lidocaine Atomization Inhalation in Bronchoscopy

ABSTRACT Objective: To compare the efficacy and safety of ultrasound-guided superior laryngeal nerve block combined with lidocaine atomization inhalation and lidocaine gargle in the diagnosis and treatment of bronchoscopy. Methods: 120 patients who underwent tracheoscopy for the first time in the Third Affiliated Hospital of Xinjiang Medical University were randomly divided into 4 groups. Lidocaine gargle group: 2% lidocaine hydrochloride injection for throat gargle; Lidocaine atomization inhalation group: 2% lidocaine injection atomization inhalation; Superior laryngeal nerve block group: block the internal branches of bilateral superior laryngeal nerve with 1% lidocaine under the localization of B-ultrasound. Combined group: combined use of ultrasound-guided superior laryngeal nerve internal branch block and lidocaine atomization inhalation. The cough, wheezing, body movement times, blood pressure, heart rate, blood oxygen saturation and visual analog score (VAS) of pain after diagnosis and treatment were recorded. Results: The incidence of choking cough and wheezing in lidocaine gargle group was the highest, which was significantly higher than that in other groups (P<0.01); The incidence of choking cough and wheezing in the combined group was the lowest, which was significantly lower than that in the other groups(P<0.05). The blood pressure and heart rate in lidocaine gargle group were significantly higher than those in each group when bronchoscope entered glottis and endotracheal diagnosis and treatment(P<0.01); The mean arterial pressure and heart rate in the combined group were lower than those in the other two groups(P<0.05). SpO₂ was higher than 90% in each group, the lowest in lidocaine gargle group(P<0.01) and the highest in combination group(P<0.05). The VAS score of pain in each group was mostly lower than 3 points, but there were differences among the groups(P<0.05), and the combined group was the lowest (P<0.05). Conclusion: Ultrasound guided internal branch block of superior laryngeal nerve combined with lidocaine atomization inhalation for bronchoscopy diagnosis and treatment can effectively inhibit tracheal stress response, reduce pain stimulation, and maintain hemodynamic stability during diagnosis and treatment, Its safety and effectiveness are better than lidocaine gargle and lidocaine atomization inhalation or ultrasound-guided superior laryngeal nerve block alone. During the diagnosis and treatment of bronchoscopy, most patients have mild pain. Choking and wheezing caused by throat discomfort are the reasons why the patients are difficult to tolerate.