超声引导下喉上神经阻滞对高血压患者插管引起血流动力学变化的影响：一项随机临床试验。

文献信息

中文摘要

背景与目的： 喉镜检查和气管内插管与交感神经反应相关，这对高血压患者有害。用喉上神经内支阻滞（iSLNB）阻断喉部传入反射可能减弱这种反应。本研究旨在评估超声引导下双侧iSLNB作为全身麻醉（GA）辅助手段在减弱高血压患者插管血流动力学反应方面的有效性。
方法： 这项前瞻性、随机、单盲临床试验纳入了在气管插管全身麻醉下接受择期非气道手术的成年高血压患者。参与者被随机分配到两组。iSLNB组在静脉诱导后接受使用利多卡因的超声引导下双侧iSLNB，而对照组接受标准静脉诱导。主要结局是插管前至插管后一分钟平均血压的变化（∆MBP）。次要结局包括收缩压和舒张压的变化、预定时间点的心率、术后咽喉痛的发生率和严重程度，以及操作相关不良事件。
结果： 共分析50名患者，每组25名。与对照组相比，iSLNB组插管后一分钟MBP的变化显著较低（平均差6.2 mm Hg；95%置信区间0.73-11.67；P = 0.03），而研究期间心率变化相当。iSLNB组术后咽喉痛显著较低（P = 0.01），且未观察到阻滞相关不良事件。
结论： 超声引导下iSLNB作为GA辅助手段有效减弱气管内插管的血流动力学反应。

英文摘要

BACKGROUND AND AIMS: Laryngoscopy and endotracheal intubation are associated with a sympathetic response which is detrimental in hypertensive patients. Blocking afferent laryngeal reflexes with the internal branch of the superior laryngeal nerve block (iSLNB) may attenuate this response. This study aimed to evaluate the effectiveness of ultrasound-guided bilateral iSLNB as an adjunct to general anaesthesia (GA) in blunting the haemodynamic response to intubation in patients with hypertension.
METHODS: This prospective, randomised, single-blind clinical trial enroled adult patients with hypertension undergoing elective non-airway surgery under GA with tracheal intubation. Participants were randomly allocated to two groups. The iSLNB group received ultrasound-guided bilateral iSLNB using lignocaine following intravenous induction, while the control group received standard intravenous induction. The primary outcome was change in mean blood pressure (∆MBP) from pre-intubation to one-minute post-intubation. Secondary outcomes included change in systolic and diastolic blood pressure, heart rate at predefined intervals, incidence and severity of postoperative sore throat, and procedure-related adverse events.
RESULTS: A total of 50 patients were analysed, 25 in each group. The change in post-intubation MBP at one minute was significantly lower in the iSLNB group compared to the control group (mean difference 6.2 mm Hg; 95% confidence interval 0.73-11.67; P = 0.03), while changes in heart rate were comparable during the study period. The postoperative sore throat was significantly lower in the iSLNB group (P = 0.01), and no block-related adverse events were observed.
CONCLUSION: Ultrasound-guided iSLNB as an adjunct to GA effectively attenuates the haemodynamic response to endotracheal intubation.