甲状腺手术后I-gel与气管插管术后咽痛发生率的比较：一项随机观察性试验。

Comparison between I-gel and endotracheal intubation in terms of the incidence of postoperative sore throat following thyroid surgery: a randomized observational trial.

作者信息

Ning Meng, Zhong Weiwei, Li Jin, Wang Tingting, Lu Yao

机构信息

Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University Hefei 230022, Anhui Province, China.

Ambulatory Surgery Center, The First Affiliated Hospital of Anhui Medical University Hefei 230022, Anhui Province, China.

出版信息

Am J Transl Res. 2022 Jan 15;14(1):373-380. eCollection 2022.

PMID:35173855

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8829600/

Abstract

BACKGROUND

Postoperative sore throat (POST) is a common complication following thyroid surgery with an endotracheal tube (ET). The I-gel is a supraglottic airway device that has greater advantages in airway management compared with ET. This prospective trial aimed to explore the potential benefits of I-gel compared with ET on POST.

METHODS

In this trial, 106 patients, classified using the American Society of Anesthesiologists (ASA) physical status classification system, belonging to classes I and II, aged 18-65 years old who were prearranged for elective radical thyroidectomy, were randomly divided into the ET and I-gel groups. All patients underwent total intravenous anesthesia (propofol, sufentanil, and cisatracurium). The incidence and severity of POST and postoperative hoarseness (PH) at 1, 6, 24, and 48 h following the operation were assessed and compared between the two groups. Moreover, the hemodynamic data during anesthesia were recorded and compared. Opioid consumption (sufentanil, propofol, and remifentanil) and postoperative nausea and vomiting were recorded. The visual analog scale scores for pain at the incision site 1, 6, 24, and 48 h postoperatively and Ramsay Sedation Scale scores were also evaluated and recorded.

RESULTS

No significant difference was observed in the incidence of POST 1, 6, 24, and 48 h postoperatively (61.2% vs. 51.0%, =0.309; 75.5% vs. 83.7%, =0.316; 83.7% vs. 85.7%, =0.779; and 12.2% vs. 22.4%, =0.182, respectively) and the severity of sore throat (=0.392) following surgery between the ET and I-gel groups. The incidence of PH in the I-gel group was significantly lower than that in the ET group 1, 6, 24, and 48 h postoperatively (all <0.05). Compared with the ET group, a significantly less fluctuation in heart rate 1 min after intubation (=0.045) and extubation (=0.001) was observed in the I-gel group.

CONCLUSIONS

Although the I-gel cannot reduce the incidence and severity of POST in patients with normal BMIs following thyroid surgery, it can reduce the occurrence and severity of PH compared with ET. The I-gel showed superior results in terms of insertion time and better hemodynamic condition during intubation.

摘要

背景

术后咽痛（POST）是甲状腺手术使用气管内插管（ET）后的常见并发症。I-gel是一种声门上气道装置，在气道管理方面比ET具有更大优势。这项前瞻性试验旨在探讨I-gel与ET相比对POST的潜在益处。

方法

在本试验中，106例根据美国麻醉医师协会（ASA）身体状况分类系统分为I级和II级、年龄在18至65岁、预定进行择期根治性甲状腺切除术的患者被随机分为ET组和I-gel组。所有患者均接受全静脉麻醉（丙泊酚、舒芬太尼和顺式阿曲库铵）。评估并比较两组患者术后1、6、24和48小时POST的发生率和严重程度以及术后声音嘶哑（PH）情况。此外，记录并比较麻醉期间的血流动力学数据。记录阿片类药物用量（舒芬太尼、丙泊酚和瑞芬太尼）以及术后恶心和呕吐情况。还评估并记录术后1、6、24和48小时切口部位疼痛的视觉模拟量表评分以及 Ramsay 镇静量表评分。

结果

术后1、6、24和48小时POST的发生率（分别为61.2%对51.0%，P = 0.309；75.5%对83.7%，P = 0.316；83.7%对85.7%，P = 0.779；12.2%对22.4%，P = 0.182）以及术后咽痛的严重程度（P = 0.392）在ET组和I-gel组之间均未观察到显著差异。I-gel组术后1、6、24和48小时PH的发生率均显著低于ET组（均P < 0.05）。与ET组相比，I-gel组在插管后1分钟（P = 0.045）和拔管后（P = 0.001）心率波动明显更小。