预防性使用地塞米松可降低双腔气管导管拔管后咽痛及声嘶发生率

背景：手术后咽痛及声嘶是气管插管，特别是双腔气管导管插管后的主要并发症。我们开展此项前瞻、随机、双盲的安慰剂对照研究，来评价地塞米松用以降低手术后咽痛及声嘶发生率和严重程度的效能。方法本研究选择了166例（18～75岁）使用双腔气管导管插管的胸外科手术患者。在全麻诱导之前，以双盲、前瞻性的随机方法分为地塞米松（静脉给予）0．1mg／kg组（D1组）、0．2mg／kg组（D2组）和安慰剂组（P组）。分别记录Cormack—Lehane评分的声门暴露度、双腔管插管阻力、尝试插管次数、完成插管时间以及插管维持时间。在拔管后1及24小时，利用视觉模拟评分（VAS，0=没有疼痛；100=可以想象的最剧烈疼痛）来评价咽痛及声嘶程度。结果拔管1小时后，咽痛、声嘶发生率及咽痛程度与P组（53％，36％，VAS30．9）相比，D1组（31％，P=0．021；11％，P=0．003；VAS12．4，P〈0．001）与D2组（11％，P=0．001；4％，P=0．001；VAS6．6，P〈0．001）均低。拔管24小时后，D2组（27％，P=0．002；15％，P=0．001；VAS29．9，P〈0．002）咽痛、声嘶发生率及咽痛程度显著低于D1组（47％，31％，VAS43．9）及P组（57％，45％，VAS51．3）。同时未发现与注射地塞米松相关的并发症的发生。结论预防性使用0．2mg／kg地塞米松能显著降低双腔气管导管拔管后１及24小时咽痛、声嘶发生率及严重程度。

BACKGROUND： Postoperative sore throat and hoarseness are common complications after tracheal intubation, particularly after using a double-lumen endobronchial tube （DLT）. We conducted a prospective, randomized, doubleblind, placebo-controlled study to evaluate the efficacy of dexamethasone for reducing the incidence and severity of postoperative sore throat and hoarseness. METHODS： One hundred sixty-six with a DLT were enrolled. Before induction of general anesthesia, 0. 1 patients （aged 18-75 yr） scheduled for thoracic surgery mg/kg dexamethasone （Group D1 ）, 0. 2 mg/kg dexamethasone （Group D2）, or a placebo （Group P） were infused IV in a double-blind and prospectively randomized manner. Glottic exposure as defined by Cormack and Lehane score, resistance to DLT insertion, number of intubation attempts, time to achieve intubation, and the duration of tracheal intubation were recorded. At 1 h and 24 h after tracheal extubation, the patients were evaluated for sore throat and hoarseness using a visual analog scale （VAN; where 0 = no pain and 100 = worst pain imaginable）. RESULTS： One hour after tracheal extubation, the incidence of postoperative sore throat and hoarseness, along with the severity of sore throat were lower in Group D1 （31%, P = 0. 021; 11%, P = 0. 003; and VAS 12.4, P 〈 0.001, respectively） and D2 （11%, P = 0.001; 4%, P = 0.001; and VAN 6.6, P 〈 0.001, respectively） compared with Group P （53%, 36% and VAS 30. 9, respectively）. Twenty-four hours after tracheal extubation, the incidence of postoperative sore throat, hoarseness, and the severity of sore throat were significantly lower in Group D2 （27%, P = 0. 002; 15%, P = 0. 001; and VAN 29.9, P 〈 0. 002, respectively） compared with Group D1 （47%, 31%, and VAS = 43.9, respectively） and Group P （57%, 45%, and VAS = 51.3, respectively）. There was no complication associated with the dexamethasone admin- istration. CONCLUSIONS： The prophylactic use of 0. 2 mg/kg of dexamethasone significantly decreases the incidence and severity of sore throat and hoarseness 1 h and 24 h after tracheal extubation of a DLT