快通道胃肠手术后咽部并发症处理方法的比较

Comparison of treatments for throat complications after fast-track gastrointestinal surgery

目的探讨一种有效防治快通道胃肠道手术后咽部并发症的处理方法,以更好满足临床和患者的要求。方法采用前瞻性、随机、双盲的研究方法,选择本院拟在全麻下行开腹胃肠道手术者280例,随机分为4组,各70例,A组(对照组),气管导管用医用石蜡油润滑;B组,气管导管用丁卡因胶浆润滑;C组,气管导管用丁卡因胶浆润滑+插管后静注地塞米松10 mg;D组,C组基础上加静注帕瑞昔布钠40 mg。记录并比较各组麻醉拔管后10 min、30 min、1 h、6 h、12 h、24 h时的术后咽喉痛(POST)发生率及严重程度,观察在PACU期间1 h内的吸痰例数。结果拔管后10 min观察点同期比较,B、C、D组POST发生率低于A组(P<0.05);30 min观察点同期比较,B、C、D组POST发生率低于A组(P<0.05),D组分别低于B、C组(P<0.05);1 h观察点同期比较,B、C、D组POST发生率低于A组(P<0.05),D组分别低于B、C组(P<0.05);6 h观察点同期比较,D组POST发生率低于A组(P<0.05);12 h、24 h观察点组间POST发生率差异无统计学意义。在PACU观察期间的吸痰人数,C、D组发生率低于A、B组(P<0.05);A、B组之间,C、D组间发生率差异无统计学意义。结论气管导管润滑复合静脉用药的多模式处理可有效防止POST,复合静注激素可有效减少拔管后气道分泌物。

Objective To investigate the requirements for an effective processing strategy forpost-operative sore throat(POST) to better meet the fast-track gastrointestinal surgery needs. Methods With prospective, randomized, double-blind study method, 280 patients under general anesthesia for gas-trointestinal surgery were randomly divided into four groups. Group A: lubricated the head of tracheal tubewith paraffin oil; Group B: lubricated the head of tracheal tube with tetracaine jelly; Group C: lubricatedthe head of tracheal tube with tetracaine jelly and 10 mg Dexamethasone i.v; Group D: lubricated the headof tracheal tube with tetracaine jelly and 10 mg Dexamethasone + 40 mg Dynastat i.v. A blinded observerinterviewed all patients on postoperative sore throat and hoarseness at 10 min, 30 min,1 h, 6 h, 12 h, 24 hafter extubation. Results In the 10 min observation point after extubation, the incidence of POST ingroup B, C, D was lower than group A(P<0.05). At the 30 min and 1 h observation points, the incidenceof POST in group B、C, D was lower than group A(P<0.05); the incidence of POST in group D was lowerthan group C and B(P<0.05). In the 6 h observation point after extubation, the incidence of POST ingroup D was lower than group A(P<0.05); At the 12 h and 24 h observation points after extubation, the in-cidence of POST had no significant differences among groups. During PACU observation period, the inci-dence of suction in group C and D was lower than group A and B(P<0.05). Conclusion Multi-modaltreatment of endotracheal tube lubricating composite intravenous drug can prevent POST, and intravenousinjection of hormones can reduce airway secretions after extubation.