氯胺酮和硫酸镁漱口预防双腔支气管插管拔管后咽喉痛的比较

目的 比较氯胺酮和硫酸镁漱口预防双腔支气管插管拔管后咽喉痛的效果。 方法 选择2015年6月-2016年4月浙江省人民医院120例择期胸腔镜下肺大泡切除术患者,采用随机数字表法随机分为对照组(C组)、氯胺酮组(K组)及硫酸镁组(M组)。麻醉诱导前15 min,C、K及M组分别给予内含生理盐水2 ml、氯胺酮0.5 mg/kg及硫酸镁20 mg/kg的5%葡糖糖漱口液30 ml漱口1 min。观察手术结束后拔除双腔支气管导管时即刻(T₁)、拔除后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的发生情况;采用间接喉镜观察T₂时患者声门充血(或/和水肿)发生情况;检测患者术前(T₀)、T₁、T₂、T₃及T₄五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 K组及M组拔管后即刻及拔管后6 h,咽喉部疼痛发生率、VAS评分、TNF-α及IL-6浓度均低于C组(P<0.05);M组拔管后即刻及拔管后6 h,咽喉部疼痛发生率、VAS评分、声音嘶哑发生率、吞咽困难发生率、TNF-α及IL-6浓度均低于K组(P<0.05);M组拔管后6 h声门充血(或/和水肿)发生率低于K组(P<0.05)。 结论 氯胺酮和硫酸镁漱口均可通过抗炎作用有效预防双腔支气管插管拔管后咽喉痛的发生,比较而言,硫酸镁漱口效果更好。 

Comparison of the effect of ketamine and magnesium sulfate gargle in preventing sore throat after removal of a double-lumen endobronchial tube

Objective To compare the effect of ketamine and magnesium sulfate gargle in preventing sore throat after removal of a double-lumen endobronchial tube. Methods A total of 120 patients with elective thoracoscopic resection of giant bullae in our hospital between June, 2015 and April, 2016 were randomized into group C(control), group K(ketamine) and group M(magnesium sulfate). The patients rinsed their mouths out with 2 ml normal saline in group C, 30 ml ketamine gargle(0.5 mg/kg, dissolved in 5% dextrose water) in group K, and 30 ml magnesium sulfate gargle(20 mg/kg, dissolved in 5% dextrose water) in group M just 15 minutes before the operation. The incidence of sore throat by visual analogue scale(VAS), hoarseness of voice and dysphagia were recorded immediately after extubation(T₁) and then 6 h(T₂), 24 h(T₃), and 48 h(T₄) after extubation. The vocal congestion and/or vocal edema were examined by indirect laryngoscopy at T₂. The levels of TNF-α, IL-6 and IL-10 at T₀(before surgery), T₁, T₂, T₃ and T₄ were tested. Results The incidence rate and VAS of sore throat were significantly lower in group K and group M than that in group C at T₁, T₂ and T₃(P<0.05). The incidence rate and sore VAS of sore throat were significantly lower in group M than that in group K at T₁ and T₂(P<0.05). The incidence rate of hoarseness of voice and dysphagia were significantly lower in group K and group M than that in group C at T₁, T₂ and T₃ time point(P<0.05). The incidence rate of hoarseness of voice and dysphagia were significantly lower in group M than that in group K at T₁ and T₂ point(P<0.05). The incidence rate of vocal congestion and/or vocal edema was significantly lower in group K and group M than that in group C at T₂ point(P<0.05). The incidence rate of vocal congestion and/or vocal edema was significantly lower in group M than that in group K at T₂ point(P<0.05). The levels of TNF-αand IL-6 were significantly lower in group K and group M than that in group C at T₁ and T₂ point. The level of IL-10 were significantly higher in group K and group M than that in group C at T₁ and T₂ points(P<0.05). The level of TNF-α and IL-6 were significantly lower in group M than that in group K at T₁ and T₂ points(P<0.05). Conclusion Either ketamine gargle or magnesium sulfate gargle can effectively reduce the incidence and severity of sore throat after tracheal intubation using a double-lumen endobronchial tube by their anti-inflammatory effects. Comparing with ketamine gargle, magnesium sulfate gargle is more effective.