天津医药

天津医药 ›› 2026, Vol. 54 ›› Issue (2): 179-183.doi: 10.11958/20253015

• 临床研究 • 上一篇    下一篇

超声引导下喉上神经阻滞在保留自主呼吸气管插管中的应用效果

李文娣1(), 王焕玲2, 杨学伟1, 谢淑华1, 张军2,△()   

  1. 1 天津市人民医院，南开大学第一附属医院麻醉科（邮编300121）
    2 疼痛科
  • 收稿日期:2025-09-26 修回日期:2025-12-10 出版日期:2026-02-15 发布日期:2026-02-12
  • 通讯作者: 张军 E-mail:tjyklwd@163.com;30119030@nankai.edu.cn
  • 作者简介:李文娣（1997），女，医师，主要从事临床麻醉方面研究。E-mail：tjyklwd@163.com
  • 基金资助:
    天津市自然科学基金面上项目(21JCYBJC00030);天津麻醉科研发展计划项目(TJMZ2021-M220)

The application effect of ultrasound-guided superior laryngeal nerve block in endotracheal intubation with preserved spontaneous breathing

LI Wendi1(), WANG Huanling2, YANG Xuewei1, XIE Shuhua1, ZHANG Jun2,△()   

  1. 1 Department of Anesthesiology
    2 Department of Pain, Tianjin Union Medical Center, the First Affiliated Hospital of Nankai University, Tianjin 300121, China
  • Received:2025-09-26 Revised:2025-12-10 Published:2026-02-15 Online:2026-02-12
  • Contact: ZHANG Jun E-mail:tjyklwd@163.com;30119030@nankai.edu.cn

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摘要：

目的 研究超声引导下喉上神经阻滞（SLNB）在保留自主呼吸气管插管中的安全性及有效性。方法 将60例需要进行保留自主呼吸气管插管的患者随机分成超声引导下SLNB组（L组）和声门上气道表面麻醉组（C组），每组30例。L组患者在超声引导下用2%利多卡因行双侧SLNB，C组用2%利多卡因依次对口咽部、悬雍垂、双侧腭扁桃体、舌根、会厌、梨状隐窝、声门进行表面麻醉。2组均通过环甲膜穿刺对气管进行表面麻醉，药物选用1%丁卡因。观察指标包括置入喉镜达会厌根部时（T2）、气管导管置入声门即刻（T3）、气管导管置入气管后导管套囊充气时（T4）的恶心呛咳评分；次要观察指标包括患者入室后3 min（T0）、气管插管前（T1）及气管插管完成后（T5）患者平均动脉压（MAP）、心率（HR）的变化，声门开放情况、术后24 h咽喉痛评分、术后恶心呕吐、声音嘶哑、穿刺部位血肿、感染、神经损伤的发生率以及患者满意度。结果 与C组比较，L组T2及T3时恶心呛咳评分降低（P<0.05），T4时2组患者的恶心呛咳评分差异无统计学意义（P>0.05）。2组气管插管前后MAP和HR变化差异无统计学意义（P>0.05）。与C组比较，L组声门开放情况评分更低，更有利于气管插管（P<0.01）；术后24 h，L组患者术后咽喉痛评分降低（P<0.01），满意度评分升高（P<0.05）。C组术后出现恶心呕吐1例，L组术后恶心呕吐2例、术后声音嘶哑1例，2组不良反应发生率差异无统计学意义（3.3% vs. 10.0%，χ2=1.071，P>0.05）。结论 超声引导下SLNB的应用可以提高患者在保留自主呼吸气管插管过程中的安全性及有效性，减轻恶心呛咳及术后咽喉痛。

关键词: 喉神经, 神经传导阻滞, 插管法，气管内, 超声引导, 呛咳, 术后咽喉痛

Abstract:

Objective To study the safety and efficacy of ultrasound-guided superior laryngeal nerve block (SLNB) in endotracheal intubation with preserved spontaneous breathing. Methods Sixty patients requiring endotracheal intubation with preserved spontaneous breathing were randomly divided into the ultrasound-guided SLNB group (group L) and the supraglottic airway surface anesthesia group (group C), with 30 cases in each group. Patients in the group L underwent bilateral SLNB under ultrasound guidance with 2% lidocaine. In the group C, 2% lidocaine was used successively for surface anesthesia of the pharynx, palatine tonsils, base of the tongue, epiglottis, piriform crypts and glottis. Both groups underwent surface anesthesia of the trachea through cricothyroid membrane puncture, and 1% tetracaine was selected as the drug. The main observation indicators included the nausea and choking cough scores when the laryngoscope was inserted to the root of the epiglottis (T2), immediately after the tracheal tube was inserted into the glottis (T3) and when the tube sleeve was inflated after the tracheal tube entered the trachea (T4). Secondary observation indicators included changes in mean arterial pressure (MAP), heart rate (HR), vocal cord movement, 3 min after the patient entered the room (T0), before tracheal intubation (T1) and after tracheal intubation (T5). The incidence rates of sore throat score, postoperative nausea and vomiting, hoarseness, hematoma at the puncture site, infection and nerve injury, as well as patient satisfaction were also recorded. Results Compared with the group C, the nausea and choking cough scores were decreased at T2 and T3 in the group L (P < 0.05), while there were no statistically significant differences in nausea and choking cough scores between the two groups at T4 (P > 0.05). There were no significant differences in MAP and HR before and after tracheal intubation between the two groups (P > 0.05). Compared with the group C, the vocal cord activity was more conducive to the operation of tracheal intubation in the group L (P < 0.01). At 24 hours after the operation, the postoperative sore throat score was decreased in patients of the group L (P < 0.01), and the satisfaction score increased (P < 0.05). In the group C, there was one case of postoperative nausea and vomiting. In the group L, there were 2 cases of postoperative nausea and vomiting, 1 case of postoperative hoarseness. There was no significant difference in the incidence of adverse reactions between the two groups (3.3% vs. 10.0%, χ2=1.071, P>0.05). Conclusion The application of SLNB under ultrasound guidance can enhance the safety and effectiveness of patients during the process of endotracheal intubation with preserved spontaneous breathing, relieve nausea, choking cough and postoperative sore throat.

Key words: laryngeal nerves, nerve block, intubation, intratracheal, ultrasound guided, cough, postoperative sore throat

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