1 中国科学技术大学附属第一医院麻醉科，合肥 230001
目的：观察局部麻醉药雾化吸入后联合纤维支气管镜(FOB)和硬膜外导管给药表面麻醉对颈椎手术患者经鼻纤支镜引导清醒插管的效果。方法：选择颈椎损伤患者40例，年龄18~71岁，ASA分级I或II级，采用随机数字表法分为2组(n=20)：局部麻醉药雾化吸入后联合FOB和硬膜外导管组(I组)及喷雾后FOB注药孔组(II组)。I组：l%丁卡因3 mL雾化吸入，FOB经鼻腔到达声门上方、声门下2 cm后分别由硬膜外导管缓慢推注2%利多卡因2 mL；II组：1%丁卡因采用经喷壶行口咽部喷雾麻醉，经鼻腔到达声门上方、声门下2 cm经注药孔快速推注2%利多卡因2 mL。两组表面麻醉后3 min经鼻FOB引导插管。在表面麻醉过程中体动呛咳明显需重复上一步操作，若补救后仍不能耐受，则予以环甲膜穿刺给药后插管。记录两组患者血流动力学变化、插管情况及满意度情况。结果：I组患者的心率(HR)及平均动脉压(MAP)在气管导管过鼻后孔(T3)时较入室后5 min(T0)时有明显增高(P<0.05)，II组患者的HR及MAP在T1~T4时较T0时有明显增高(P<0.05)；与I组比较，II组患者的HR及MAP在T1~T4时明显增高(P<0.05)；II组患者环甲膜穿刺率高、表面麻醉时间缩短、补救率升高、呛咳和体动的发生率升高、患者满意度评分降低(P<0.05)；两组患者插管时间和插管成功率无明显差异(P>0.05)。结论：对于需要清醒插管的颈椎损伤手术患者，雾化吸入后联合FOB和硬膜外导管给药可达到较为可靠的表面麻醉效果，并能降低不良反应的发生，优于喷雾后单纯经FOB注药孔给药。关键词： 雾化吸入；清醒气管插管；纤维支气管镜；表面麻醉
Effect of local anesthetic nebulization inhalation combined with topical anesthesia on patients with awake tracheal intubation
CorrespondingAuthor: HUANG Xiang Email: firstname.lastname@example.org
Foundation: This work was supported by the National Natural Science Foundation, China (81801175).
Objective: To investigate the effect of combination of fiberoptic bronchoscope and epidural catheterized topical anesthesia after nebulized inhalation on conscious tracheal intubation in patients with cervical spine surgery. Methods: A total of 40 patients with cervical spine injuries, aged 18 to 71 years, with ASA grade I or grade II, were randomly divided into 2 groups using random number table method (n=20): combination of fiberoptic bronchoscope and epidural catheterized topical anesthesia after local anesthetic nebulized inhalation (group I) and FOB injection after spraying group (group II). Group I: 1% tetracaine 3 mL nebulized inhalation, FOB through the nasal cavity to reach above the glottis, 2 cm below the glottis, and then slowly inject 2% lidocaine 2 mL from the epidural catheter; Group II: oral and pharyngeal spray anesthesia was performed with 1% tetracaine spray, and then quickly injected 2% lidocaine 2 mL through the nasal cavity to the top of the glottis and the subglottic 2 cm through the injection hole. Nasal FOB-guided intubation was performed 3 minutes after anesthesia in both groups. In the process of topical anesthesia, the previous procedures were repeated. If the patients were not still tolerated after remedy, it was intubated after puncture and administration. Record hemodynamic changes, intubation and satisfaction of two groups of patients. Results: The HR and MAP in group I were significantly higher at T3 compared with that of T0 (P<0.05), and were significantly higher at T1−4 than that of T0 in group II (P<0.05). The HR and MAP of patients in group II were significantly higher than those in group I at T1−4 (P<0.05). Compared with group I, patients in group II had reduced topical anesthesia time and satisfaction, increased cyclomembrane puncture rate, rate of remedy, cough and body movements. No significant difference in intubation time and intubation success rate between the 2 groups. Conclusion: For patients with cervical spine injury requiring conscious intubation, nebulized inhalation combined with FOB and epidural catheter can achieve more reliable topical anesthesia, and can reduce the incidence of adverse reactions, which is better than injection via FOB hole after spraying.Keywords： nebulized inhalation; awake endotracheal intubation; fiber bronchoscope; topical anesthesia