文笛 陈昌林 万勇 余祺

[摘要]在全身麻醉气管插管中，困难气道大多能被提前发现。既往的气道管理或术前的气道检查可以帮助麻醉医生对潜在的困难进行风险评估。清醒插管是解决预期困难气道常用的方法，对预期的困难气道患者采用清醒插管可以保障患者气道的安全，减少严重不良反应的发生。而成功的清醒插管離不开完善的气道局部麻醉。在清醒插管中，成功的气道局部麻醉是一个独特的挑战。目前临床上关于气道局部麻醉的方法有很多，本文为探讨适用于清醒气管插管的气道局部麻醉方法，将简要介绍当前常用的局部麻醉药物如利多卡因、丁卡因、罗哌卡因等，以及雾化、喷洒、神经阻滞等常用局部麻醉方法在清醒气管插管中的具体应用，结合既往研究将气道局部麻醉的方法做出简要对比，讨论这几种方法各自的优势和缺陷以及应用前景。[关键词]清醒插管;困难气道;表面麻醉;神经阻滞;纤支镜;雾化

[中图分类号] R614.2;R-1  [文献标识码] A   [文章编号]2095-0616（2021）24-0062-05

Application progress of local anesthesia for awake endotracheal intubation

WEN  Di    CHEN  Changlin    WAN  Yong    YU  Qi

Department of Anesthesiology， Affiliated Hospital of North Sichuan Medical College， Sichuan， Nanchong 637000，China

[Abstract] During endotracheal intubation under general anesthesia， most difficult airways can be found in advance. The previous airway management or preoperative airway examination can help anesthesiologists assess the risks of potential difficulties. Awake intubation is a common method to solve the expected difficult airway， and it can ensure the safety of patients' airway and reduce the occurrence of serious adverse reactions. Successful awake intubation cannot be separated from perfect local airway anesthesia. Successful local airway anesthesia is a unique challenge in awake intubation. At present， there are many methods of local airway anesthesia in clinic. In order to explore the methods of local airway anesthesia suitable for awake endotracheal intubation， this paper will briefly introduce the current commonly used local anesthetics such as lidocaine， tetracaine and ropivacaine， and the specific application of atomization， spraying and nerve block in awake endotracheal intubation. Combined with previous studies， the methods of local airway anesthesia are briefly compared. The advantages， disadvantages and application prospects of these methods are discussed.

[Key words] Awake intubation; Difficult airway; Surface anesthesia; Nerve block; Bronchofiberscope; Atomization

气管插管是全身麻醉中常见的操作技术，困难气道在一般人群中的发生率为1.9%～10%[1]。Mallampati分类、头颈活动度、张口度、下颚前突功能、体重、甲颏距被纳入简化的气道风险指数评估[2]。对预期的困难气道患者采用清醒插管可以在气管插管过程中维持患者自发性通气和固有气道张力，保障患者气道的安全，减少严重不良反应如误吸、窒息等的发生[3-4]。尽管清醒气管插管有很高的成功率和良好的安全性，但实际应用率却很低，这与操作者的技术水平有限、处理困难气道理念落后、清醒插管流程不熟悉、清醒插管所需工具缺乏等均有明显的关系。……