经前路喉上神经阻滞复合瑞马唑仑用于高血压患者清醒插管的临床研究

doi:10.13591/j.cnki.kqyx.2026.08.004

摘要/Abstract

摘要：

目的探索超声引导下的经前路双侧喉上神经阻滞复合瑞马唑仑在高血压患者困难气道清醒插管中的应用效果及安全性。方法选择择期行全麻手术的需清醒插管的困难气道患者60例,既往有高血压病史,SBP/DBP≤140/90 mmHg,年龄18~65岁,18.5≤BMI<28 kg/m²,ASAⅡ~Ⅲ级。采用随机数表法将患者分为两组:对照组(C组)和观察组(S组),每组30例。C组患者行环甲膜穿刺气道表面麻醉,S组患者行超声引导下的前路双侧喉上神经阻滞联合环甲膜穿刺气道表面麻醉,两组患者均静脉予瑞马唑仑0.1 mg/kg,鼻腔表麻后实施纤维支气管镜引导下经鼻清醒气管插管。记录患者麻醉前(T₀)、导管进入声门即刻(T₁)、插管完成即刻(T₂)、插管后3 min(T₃)和拔管后即刻(T₄)的血流动力学指标,包括平均动脉压(MAP)和HR。记录插管前的Ramsay镇静评分;插管过程中低氧血症、呛咳、恶心以及拔管后的声音嘶哑、咽痛的发生情况。结果与T₀相比,S组各时间点MAP的升高无统计学意义,HR在T₁、T₂、T₃、T₄时刻显著升高(P<0.05);C组T₁、T₂、T₃、T₄时刻MAP、HR均显著上升(P<0.05)。两组患者各时间点的MAP和HR差异无统计学意义。S组患者插管过程呛咳的发生率显著低于C组,其余不良反应两组差异无统计学意义。结论超声引导下的经前路喉上神经阻滞复合瑞马唑仑可以减少高血压患者清醒插管时的血流动力学波动,降低插管过程中呛咳的发生率,有助于控制操作过程中的应激反应,提高患者的舒适度。

关键词: 喉上神经阻滞, 超声引导, 高血压, 瑞马唑仑, 困难气道

Abstract:

Objective To evaluate the clinical efficacy and safety of the anterior approach for ultrasound-guided superior laryngeal nerve (SLN) block combined with remimazolam for awake tracheal intubation in patients with hypertension and difficult airways. Methods A total of 60 patients with difficult airways and hypertension scheduled for general anesthesia surgery, SBP/DBP≤140/90 mmHg, aged 18-65 years, 18.5≤BMI<28 kg/m², ASA physical statusⅡ-Ⅲ were selected. These patients were randomly divided into a control group(group C) and an observation group(group S) by random number table, 30 patients in each group. The control group received cricothyroid membrane puncture anesthesia, while the observation group received the anterior approach for ultrasound-guided SLN block combined with cricothyroid membrane puncture anesthesia. Both groups of patients received intravenous remimazolam at a dose of 0.1 mg/kg, nasal surface anesthesia and then underwent fiberoptic bronchoscope-guided awake tracheal intubation through the nasal route. MAP and HR were recorded at baseline(T₀), immediately after the tracheal tube enters the glottis(T₁), immediately after the tracheal tube enters the trachea(T₂), 3 min after the tracheal tube enters the trachea(T₃), immediately after extubation(T₄). The Ramsay sedation score was recorded before intubation along with the occurrence of hypoxemia, cough, nausea during intubation, as well as hoarseness and sore throat after extubation. Results Compared with T₀, the increase of MAP at each time point in group S was not statistically significant and HR increased significantly at T₁,T₂, T₃, T₄(P<0.05). In group C, MAP and HR increased significantly at T₁, T₂, T₃ and T₄. There was no statistically significant difference in MAP and HR between the two groups at each time point. The incidence of cough during intubation in group S was significantly lower than that of group C(P<0.05). There was no statistically significant difference in other adverse reactions between the two groups. Conclusion The anterior approach for ultrasound-guided SLN block combined with remimazolam can reduce hemodynamic fluctuations during awake tracheal intubation in patients with hypertension, lower the incidence of coughing during intubation, help control the stress response and improve patient comfort.

Key words: superior laryngeal nerve block, ultrasound-guided, hypertension, remimazolam, difficult airway

中图分类号:

R614.2

张悦, 茆梦, 尹楠, 吴波, 孙强, 余伊. 经前路喉上神经阻滞复合瑞马唑仑用于高血压患者清醒插管的临床研究[J]. 口腔医学, 2026, 46(8): 582-586.

ZHANG Yue, MAO Meng, YIN Nan, WU Bo, SUN Qiang, YU Yi. Clinical study on the anterior approach for superior laryngeal nerve block combined with remimazolam for awake tracheal intubation in patients with hypertension[J]. Stomatology, 2026, 46(8): 582-586.

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组别	例数	年龄/岁^a	BMI/(kg/m²)^b	性别(男/女)^c	ASA分级(Ⅱ级/Ⅲ级)^c	Ramsay评分(4分/5分)^c
C组	30	55(41~60)	24.1±2.1	19/11	25/5	14/16
S组	30	55(39~61)	24.4±1.7	17/13	26/4	13/17
P		0.684	0.532	0.598	P>0.999	0.795

指标	组别	例数	T₀	T₁	T₂	T₃	T₄
MAP/mmHg	C组	30	84.1±7.7	86.3±7.5^a	89.0±6.8^a	85.8±6.9^a	86.3±7.3^a
	S组	30	83.4±7.8	83.7±7.1	85.0±6.8	83.4±7.1	83.2±6.4
HR/(次/分)	C组	30	81.3±10.2	84.3±8.9^a	89.5±8.9^a	87.6±6.9^a	85.2±8.2^a
	S组	30	82.3±8.5	84.2±7.3^a	85.0±7.4^a	83.8±7.0^a	84.7±6.8^a

组别	例数	呛咳	恶心	躁动	低氧血症	咽痛
C组	30	9(30.0)	6(20.0)	2(6.7)	2(6.7)	12(40.0)
S组	30	2(6.7)^a	1(3.3)	0	3(10.0)	7(23.3)
P		0.020	0.371	0.492	0.500	0.165