硫酸镁漱口和复方利多卡因涂抹预防气管插管拔管后咽喉痛的比较

Comparison of the Effect of Magnesium Sulfate Gargle and Compound Lidocaine Cream Smeared in Preventing Postoperative Sore Throat

关键词:  硫酸镁  复方利多卡因  气管插管  术后并发症  咽喉痛

Key words:  magnesium sulfate  compound lidocaine cream  intubation tracheal  postoperative complications  sore throat

摘要:

目的 比较术前硫酸镁注射液漱口和复方利多卡因乳膏涂抹预防气管插管拔管后咽喉痛的效果。方法 120例择期腹腔镜下卵巢囊肿切除术的患者，随机分为对照组、硫酸镁组和复方利多卡因组，每组各40例。硫酸镁组麻醉诱导前予含硫酸镁注射液（20 mg·kg^-1漱口液30 mL）漱口1 min，复方利多卡因组气管导管的前1/3涂抹复方利多卡因乳膏。观察手术结束后拔除气管导管时即刻（T₁）、拔除气管导管后6 h（T₂）、24 h（T₃）及48 h（T₄）患者咽喉部疼痛、声音嘶哑及吞咽困难发生情况；采用间接喉镜观察T₂时患者声门充血和（或）水肿发生情况；检测患者术前（T₀）及T₁、T₂、T₃及T₄ 5个时间点血肿瘤坏死因子α（TNF-α）、白介素-6（IL-6）及白介素-10（IL-10）浓度。结果 T₁、T₂及T₃时，硫酸镁组咽喉部疼痛、声音嘶哑、吞咽困难发生率及VAS评分均低于对照组及复方利多卡因组（P<0.05）。T₂时，硫酸镁组声门充血的发生率低于对照组及复方利多卡因组（P<0.05）。T₁和T₂时，硫酸镁组TNF-α及IL-6均低于同时点对照组及复方利多卡因组（P<0.05），IL-10均高于同时点对照组及复方利多卡因组（P<0.05）；同时，复方利多卡因组TNF-α及IL-6均低于同时点对照组，IL-10均高于同时点对照组，但除拔管后6 h IL-6（P<0.05）外，其余各时点各指标与对照组比较均无差异。结论 硫酸镁漱口可通过其抗炎作用有效预防气管插管拔管后咽喉痛的发生；复方利多卡因乳膏涂抹虽有一定抗炎作用，但不能有效预防气管插管拔管后咽喉痛的发生。

Abstract:

OBJECTIVE To compare the effect of magnesium sulfate gargle and compound lidocaine cream smeared in preventing postoperative sore throat(POST). METHODS A total of 120 patients with elective laparoscopic ovarian cyst surgery were randomized into control group, magnesium sulfate group, and compound lidocaine cream group. Patients in magnesium sulfate group received magnesium sulfate gargle (20 mg·kg^-1 up to 30 mL dextrose water 20%) 15 min before the operation. Patients in compound lidocaine cream group received compound lidocaine cream uniformly smeared on the formost third of endotracheal tubes 5 min before the intubation. Patient complaint of postoperative sore throat, and its severity measured by visual analogue scale (VAS) were recorded at the moment of extubation immediately (T₁) and then 6(T₂), 24(T₃), and 48(T₄) hours after extubation. The incidence rates of hoarseness of voice and dysphagia were observed at T₁, T₂, T₃ and T₄. The glottis of all patients was examined by indirect laryngoscopy 6h after extubation and the incidence rate of vocal congestion and/or vocal edema were recorded. Venous blood of patient was extracted before surgery(T₀), T₁, T₂, T₃ and T₄ individually to test the concertration of TNF-α, IL-6 and IL-10. RESULTS The incidence rate and sore VAS of sore throat were significantly lower in magnesium sulfate group than that in other groups at T₁, T₂ and T₃(P<0.05). The incidence rate of hoarseness of voice and dysphagia were significantly lower magnesium sulfate group than that in other groups at T₁, T₂ and T₃(P<0.05). The incidence rate of vocal congestion and/or vocal edema was significantly lower in magnesium sulfate group than that in other groups at T₂(P<0.05). The concertration of TNF-α and IL-6 were significantly lower in magnesium sulfate group than that in other groups at T₁ and T₂. The concertration of IL-10 were significantly higher in magnesium sulfate group than that in other groups at T₁ and T₂(P<0.05). The concertration of IL-6 was significantly lower in compound lidocaine cream group than that in control group at T₂(P<0.05). CONCLUSION Magnesium sulfate gargle can effectively attenuated the incidence and severity of POST by its anti-inflammatory effects. However compound lidocaine cream smeared on the endotracheal tubes does not prevent POST.