拔管即刻布地奈德低温雾化吸入对双腔气管导管插管后咽部并发症的影响

Efficacy of early cold budesonide atomization inhalation on postoperative sore throat following double-lumen endotracheal intubation

目的探讨极早期控制性低温雾化对双腔气管导管插管后咽喉疼痛(POST)等咽部并发症的治疗作用。方法选取胸科手术双腔气管导管插管后POST相关咽喉部不适的患者105例,随机分为3组,每组35例。采用头戴式雾化口鼻吸入装置,雾化吸入时间15 min,C组拔管即刻行20℃生理盐水12 mL雾化吸入,R组拔管即刻行20℃生理盐水10 mL加布地奈德混悬液2 mL(1 mg)雾化吸入,L组拔管即刻行0℃生理盐水10 mL加布地奈德2 mL(1 mg)雾化吸入。记录拔管后1、2、6、24 h各组患者咽喉疼痛、咽喉干涩、声嘶和吞咽困难评分。术后1 d行Qo R-40量表评分。结果 L组拔管后1、2、24 h的咽喉疼痛、咽喉干涩评分显著低于C组(P<0.05),1、6、24 h吞咽困难的评分显著低于C组(P<0.05),1 h咽喉疼痛评分显著低于R组(P<0.05)。R组的各个评价指标评分拔管后1 h及以后的各个时间段均低于C组,但差异无统计学意义(P>0.05),各组患者间不同时间点声嘶评分差异均无统计学意义(P>0.05)。L组术后1 dQo R-40量表总分显著高于C组和R组(P<0.05)。结论术后双腔气管导管拔管即刻布地奈德低温雾化吸入能有效缓解POST相关并发症的程度,提高患者术后满意度,有助于加速患者术后康复。

Objective To evaluate the efficacy of early controlled cold atomization inhalation ofbudesonide in the treatment of post-operative sore throat（POST）after double-lumen endotracheal intubation.Methods A total of 105 ASA Ⅰ-Ⅲ patients having POST after thoracic surgery with double-lumen endotrachealintubation were randomly divided into three groups（n = 35 each）. The patients in the control group were treatedwith atomization inhalation of 12 mL 20 ℃ saline（Group C）and those in the observation groups were treated with10 mL 20 ℃ saline plus 2 mL（1 mg）budesonide（Group R）or 10 mL 0 ℃saline plus 2 mL（1 mg）budesonide（Group L）for 15 minutes immediately after extubation. The 4-score scale was used to evaluate sore throat,drythroat,hoarseness and swallowing difficulty 1,2,6 and 24 h after the extubation and Qo R-40 scale to assess post-operative recovery at 24 h. Results The scores of sore throat and dry throat were significant lower in group L thanthose in group C（P〈0.05）at 1,2 and 24 h and the score of swallowing difficulty（dysphagia）was also signifi-cant relieved at 1,6 and 24 h after the extubation in group L. Furthermore,the score of sore throat was significantlower in group L than that in group R（P〈0.05）at 1 h. There were no significant differences of hoarseness in three groups（P〉0.05）. The total score of Qo R-40 scale was the significantly highest in group L than that in group Cand group R（P〈0.05）24 h postoperatively. Conclusion Cold atomization inhalation of budesonide immediatelyafter the extubation of double-lumen endotracheal can alleviate POST and bring more benefits to patients whichhelp to enhance the recovery after throracic surgery.