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北京大学学报（医学版） ›› 2022, Vol. 54 ›› Issue (2): 289-293. doi: 10.19723/j.issn.1671-167X.2022.02.015

• 论著 • 上一篇    下一篇

地塞米松联合盐酸奥布卡因凝胶用于预防鼻内镜术后咽喉痛

史成梅1,王雪冬1,刘又鲲2,邓莹1,郭向阳1,△()   

  1. 1.北京大学第三医院麻醉科,北京 100191
    2.北京市中关村医院麻醉科,北京 100080
  • 收稿日期:2020-03-09 出版日期:2022-04-18 发布日期:2022-04-13
  • 通讯作者: 郭向阳 E-mail:puthmzk@hsc.pku.edu.cn
  • 基金资助:
    国家自然科学基金(81801070)

Effect of dexamethasone combined with oxybuprocaine hydrochloride gel on prevention of postoperative sore throat after nasal endoscopy

SHI Cheng-mei1,WANG Xue-dong1,LIU You-kun2,DENG Ying1,GUO Xiang-yang1,△()   

  1. 1. Department of Anesthesiology, Peking University Third Hospital, Beijing 100191, China
    2. Department of Anesthesiology, Beijing Zhongguancun Hospital, Beijing 100080, China
  • Received:2020-03-09 Online:2022-04-18 Published:2022-04-13
  • Contact: Xiang-yang GUO E-mail:puthmzk@hsc.pku.edu.cn
  • Supported by:
    National Natural Science Foundation of China(81801070)

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摘要：

目的: 探讨地塞米松联合盐酸奥布卡因凝胶用于预防鼻内镜术后咽喉痛的有效性及安全性。方法: 选择2020年1月至6月60例美国麻醉医师协会(American Society of Anesthesiologist, ASA)Ⅰ~Ⅱ级且年龄18~72岁拟在经口气管插管全身麻醉下接受鼻内镜手术的北京大学第三医院耳鼻喉科患者,随机数字表法分为地塞米松联合盐酸奥布卡因凝胶组(G组,30例)及对照组(C组,30例)。G组于麻醉诱导前静脉给予地塞米松0.1 mg/kg滴入,术前将奥布卡因凝胶涂抹气管导管套囊及前端15 cm范围内,之后进行常规的麻醉诱导、气管插管;C组于麻醉诱导前静脉给予同等体积的生理盐水,术前气管导管套囊及前端涂抹生理盐水,之后进行常规的麻醉诱导、气管插管。记录两组患者手术时间、麻醉时间、苏醒时间、拔管时间、出室时间、术中输液量、术中出血量、丙泊酚、瑞芬太尼、罗库溴铵等用药量;记录术中低血压、心动过缓、术后躁动等不良反应的发生情况。术毕及术后4、8、12、24 h进行咽喉痛随访。结果: 与C组比较,G组患者的苏醒时间[(8.4±3.9) min vs. (10.8±4.7) min]、拔管时间[(8.8±3.7) min vs. (11.9±4.8) min]、出室时间[(20.0±5.3) min vs. (23.0±5.8) min]显著缩短,丙泊酚用量[(11.8±1.8) mg/kg vs. (15.9±4.6) mg/kg]及瑞芬太尼用量[(10.9±4.7) μg/kg vs. (14.1±3.6) μg/kg]显著减少,发生低血压[10%(3/30) vs. 30%(9/30)]、心动过缓[16.7%(5/30) vs. 20%(6/30) ]及术后躁动[6.7%(2/30) vs. 23.3%(7/30)]的比例显著降低,两组患者肌松药的用量差异无统计学意义(P>0.05)。与C组比较,G组术毕即刻、术后4 h、术后8 h、术后12 h及术后24 h的咽喉痛评分[0(0, 1) vs. 1(1, 2),0(0, 0) vs. 1(1, 2), 0(0, 0) vs. 1(1, 2), 0(0, 0) vs. 1(0.75, 1), 0(0, 0) vs. 1(0, 1)]均显著降低。结论: 地塞米松联合盐酸奥布卡因凝胶可以安全有效地用于预防鼻内镜术后咽喉痛。

关键词: 地塞米松, 盐酸奥布卡因凝胶, 术后咽喉痛, 鼻内镜

Abstract:

Objective: To explore the effectiveness and feasibility of dexamethasone combined with oxybuprocaine hydrochloride gel on the prevention of postoperative sore throat after nasal endoscopy. Methods: In the study, 60 patients with American Society of Anesthesiologist (ASA) physical statuses Ⅰ to Ⅱ, aged 18 to 72 years, scheduled for elective nasal endoscope surgery under general anesthesia requiring endotracheal intubation were randomly divided into dexamethasone combined with oxybuprocaine hydrochloride gel group (G group, n=30) and control group (C group, n=30). The patients in the G group received dexamethasone 0.1 mg/kg before induction and the oxybuprocaine gel was applied to the endotracheal catheter cuff and the front end within 15 cm. The patients in the C group received the same dose of saline and the saline was applied to the endotracheal catheter cuff and the front end within 15 cm. Then, all the patients in the two groups received the same induction and anesthesia maintainance. The operation time, anesthesia time, emergence time, extubation time and departure time were recorded. The intraoperative infusion volume, blood loss volume, propofol, remifentanil, rocuronium dosage were also recorded. The adverse reactions such as intraoperative hypotension, bradycardia and postoperative agitation were recorded. The postoperative sore throat score was recorded at the end of operation and 4 h, 8 h, 12 h, and 24 h after operation. Results: Compared with the C group, the emergence time [(8.4±3.9) min vs. (10.8±4.7) min], extubation time [(8.8±3.7) min vs. (11.9±4.8) min], and departure time [(20.0±5.3) min vs. (23.0±5.8) min] were significantly shorter, and the propofol dosage [(11.8±1.8) mg/kg vs. (15.9±4.6) mg/kg], remifentanil dosage [(10.9±4.7) μg/kg vs. (14.1±3.6) μg/kg] were significantly less in the G group, and there was no difference of rocuronium dosage in the two groups. Compared with the C group the incidence of intraoperative hypotension [10%(3/30) vs. 30%(9/30)], bradycardia [16.7%(5/30) vs. 20%(6/30)] and postoperative agitation [6.7%(2/30) vs. 23.3%(7/30)] were significantly lower in the C group. The postoperative sore throat score at the end of operation, 4 h, 8 h, 12 h and 24 h after operation in the G group were significantly lower than in the C group respectively [0 (0, 1) vs. 1 (1, 2), 0 (0, 0) vs. 1 (1, 2), 0 (0, 0) vs. 1 (1, 2), 0 (0, 0) vs. 1 (0.75, 1), 0 (0, 0) vs. 1 (0, 1)]. Conclusion: Dexamethasone combined with oxybuprocaine hydrochloride gel was effective and feasible on the prevention of postoperative sore throat after nasal endoscopy.

Key words: Dexamethasone, Oxybuprocaine hydrochloride gel, Postoperative sore throat, Nasal endoscopy

中图分类号: 

  • R765.9

表1

两组患者的一般资料"

Items Group G (n=30) Group C (n=30)
Gender, female/male 13/17 12/18
Age/years, x -±s 39.5±15.5 43.5±12.9
Height/cm, x -±s 168.6±7.2 166.1±5.7
Weight/kg, x -±s 68.4±14.1 66.5±10.7
Mallampati grade, M(P25, P75) 2 (1, 2.25) 2 (1, 2)

表2

两组患者术中一般情况比较( x -±s)"

Items Group G (n=30) Group C (n=30)
Operating time/min 85.2±46.6 76.3±50.9
Transfusion volume/mL 800.0±249.1 786.7±315.9
Blood loss/mL 18.5±9.2 13.7±6.5

表3

两组患者麻醉情况比较( x -±s)"

Items Group G
(n=30)		 Group C
(n=30)
Anesthesia time/min 103.8±50.2 94.3±51.7
Emergence time/min 8.4±3.9* 10.8±4.7
Extubation time/min 8.8±3.7* 11.9±4.8
Departure time/min 20.0±5.3* 23.0±5.8
Propofol dosage/mg 805.8±259.1* 1 057.7±500.1
Remifentanil dosage/μg 748.3±340.3* 938.7±392.5
Muscular relaxant dosage/mg 48.3±4.6 49.5±12.6

表4

两组患者围术期不良反应比较"

Items Group G (n=30) Group C (n=30)
Hypotension, n(%) 3 (10.0)* 9 (30.0)
Bradycardia, n(%) 5 (16.7)* 6 (20.0)
Postoperative agitation, n(%) 2 (6.7)* 7 (23.3)

表5

两组患者术后咽喉痛评分"

Items Sore throat Group G
(n=30)		 Group C
(n=30)		 Sore throat score M(P25, P75) 95%CI
Group G (n=30) Group C (n=30) Median difference Low High
End of operation 0 21 6 0 (0, 1)* 1 (1, 2) 1 0.074 0.176
1 9 16
2 0 7
3 0 1
4 h after operation 0 25 6 0 (0, 0)* 1 (1, 2) 1 0.114 0.256
1 5 17
2 0 6
3 0 1
8 h after operation 0 27 7 0 (0, 0)* 1 (1, 2) 1 0.312 0.094
1 3 16
2 0 7
3 0 0
12 h after operation 0 27 8 0 (0, 0)* 1 (0.75, 1) 1 0.042 0.113
1 3 19
2 0 3
3 0 0
24 h after operation 0 27 13 0 (0, 0)* 1 (0, 1) 1 0.156 0.271
1 3 15
2 0 2
3 0 0
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ISSN 1671-167X
CN 11-4691/R
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