不同方法使用盐酸达克罗宁胶浆对喉罩全麻患者血流动力学及术后咽喉疼痛的影响

The influence of different usage of dyclonine hydrochloride mucilage on hemodynamics and postoperative throat pain of laryngeal mask anesthesia patients

目的 评价不同方法使用盐酸达克罗宁胶浆对喉罩全麻患者血流动力学以及术后咽喉疼痛的影响.方法 选择60例ASA Ⅰ～Ⅱ级择期喉罩全麻下输尿管软镜钬激光碎石手术患者,按盐酸达克罗宁胶浆使用的方法不同分为三组（n=20）,分别为石蜡油涂抹喉罩组（A组）、盐酸达克罗宁胶浆涂抹喉罩组（B组）、盐酸达克罗宁胶浆咽喉含漱联合涂抹喉罩组（C组）.记录三组患者留置喉罩的时间、术后自主呼吸恢复时间、呼之睁眼时间及拔喉罩时间;麻醉诱导前（T1）、拔除喉罩前1 min（T2）、拔除喉罩即刻（T3）、拔除喉罩后5 min（T4）、10 min（T5）的HR、平均血压（MBP）值;拔除喉罩后咽喉部并发症发生情况;术后拔除喉罩后30 min评估咽喉疼痛程度评级,并观察三组患者使用了盐酸达克罗宁胶浆的不良反应.结果 三组患者留置喉罩的时间、术后自主呼吸恢复时间、呼之睁眼时间及拔喉罩时间差异无统计学意义（P＞0.05）,T1、T5各时点三组患者的HR、MBP比较差异无统计学意义（P＞0.05）;T2～T4 A组较B、C两组以及B组较C组患者的HR增快、MBP升高,差异有统计学意义（P＜0.05）;B、C两组与A组比较以及C组与B组比较,咽喉痛、吞咽不适的发生率明显降低,差异有统计学意义（P＜0.05）;A、B、C三组声嘶发生率比较差异无统计学意义（P＞0.05）;咽喉疼痛程度评级：B、C两组低于A组,C组低于B组,差异均有统计学意义（P＜0.05）;A、B、C三组患者均未见过敏反应和局麻药中毒发生.结论 盐酸达克罗宁胶浆可降低苏醒期患者血流动力学的波动,有效预防和减轻喉罩全麻患者术后咽喉疼痛的发生,提高患者术后身体舒适度,且无明显不良反应发生,以盐酸达克罗宁胶浆咽喉含漱联合涂抹喉罩表面方法效果最佳.

Objective To investigate influence of different usage of dyclonine hydrochloride mucilage on hemodynamics and postoperative throat pain of laryngeal mask anesthesia patients.Methods Sixty patients in flexible ureteroscopic holmium laser lithotripsy with laryngeal mask anesthesia were randomly divided into three groups according to different usage of dyclonine hydrochloride mucilage （n =20）.Group A was coated laryngeal mask with paraffin oil.Group B was coated laryngeal mask with dyclonine hydrochloride mucilage.Group C was coated laryngeal mask with dyclonine hydrochloride mucilage and dyclonine hydrochloride mucilage gargle.The indwelling time of laryngeal mask, postoperative recovery time of spontaneous breathing, time of hearing the call to open eyes, and the time of pulling out the laryngeal mask were recorded.Heart rate （HR）, mean blood pressure （MBP） index at T1 （pre-anesthesia induction）, T2 （1 min before pulling out the laryngeal mask）, T3 （pulling out the laryngeal mask）, T4 （5 min after removing the laryngeal mask）, and T5 （10 min after removing the laryngeal mask） were recorded.The complications of throat after removing laryngeal mask were observed.The pain degree of sore-throat at the time of 30 minutes after removing the laryngeal mask was observed.The adverse reactions of the usage of dyclonine hydrochloride were observed in three groups.Results There were no statistically significant differences in indwelling time of laryngeal mask, postoperative recovery time of spontaneous breathing, time of hearing the call to open eyes, and the time of pulling out the laryngeal mask among three groups （P 〉 0.05）.There were no statistically significant differences in HR, MBP at T1 , and T5 （P 〉 0.05）.HR and MBP were higher in group A than in groups B and C at T2 ～ T4, and HR and MBP were higher in group B than in group C at T2 ～ T4, with statistically significant difference （P 〈 0.05）.The incidences of sore throat and swallowing discomfort were significantly lower in groups B and C than in group A （P 〈 0.05）.The incidences of sore throat and swallowing discomfort were significantly lower in group C than in group B （P 〈0.05）.No statistically significant difference were found in incidence of hoarseness among three groups （P〉 0.05）.The pain degree of sore-throat in group C were significantly lower than in group B, and the pain degree of sore-throat in groups B and C was significantly lower than in group A （P 〈 0.05）.There were no allergic reactions and local anesthetic poisoning for three groups.Conclusions Dyclonine hydrochloride mucilage can reduce hemodynamic fluctuations during recovery period, and prevent or relieve effectively the patient＇s throat pain after laryngeal mask anesthesia.At the same time, dyclonine hydrochloride mucilage can improve the patient＇s postoperative physical comfort without adverse reactions, especially coated laryngeal mask with dyclonine hydrochloride mucilage and dyclonine hydrochloride mucilage gargle.