快通道胃肠手术后咽部并发症处理方法的比较

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。

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

ObjectiveTo investigate the requirements for an effective processing strategy for post-operative sore throat (POST) to better meet the fast-track gastrointestinal surgery needs. MethodsWith prospective, randomized, double-blind study method, 280 patients under general anesthesia for gastrointestinal surgery were randomly divided into four groups. Group A: lubricated the head of tracheal tube with paraffin oil; Group B: lubricated the head of tracheal tube with tetracaine jelly; Group C: lubricated the head of tracheal tube with tetracaine jelly and 10 mg Dexamethasone i.v; Group D: lubricated the head of tracheal tube with tetracaine jelly and 10 mg Dexamethasone + 40 mg Dynastat i.v. A blinded observer interviewed all patients on postoperative sore throat and hoarseness at 10 min, 30 min,1 h, 6 h, 12 h, 24 h after extubation. ResultsIn the 10 min observation point after extubation, the incidence of POST in group B, C, D was lower than group A (P<0.05). At the 30 min and 1 h observation points, the incidence of POST in group B、C, D was lower than group A (P<0.05); the incidence of POST in group D was lower than group C and B (P<0.05). In the 6 h observation point after extubation, the incidence of POST in group D was lower than group A (P<0.05); At the 12 h and 24 h observation points after extubation, the incidence of POST had no significant differences among groups. During PACU observation period, the incidence of suction in group C and D was lower than group A and B (P<0.05). ConclusionMulti-modal treatment of endotracheal tube lubricating composite intravenous drug can prevent POST, and intravenous injection of hormones can reduce airway secretions after extubation.