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复方洋甘菊利多卡因凝胶对喉罩气道正压通气后口咽并发症的影响

[Effect of compound chamomile and lidocaine hydrochloride gel on oropharyngeal complications after the use of laryngeal mask airway with positive pressure ventilation].

作者信息

Wang H J, Wang S S, Wang G Y

机构信息

Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2023 Aug 22;103(31):2420-2426. doi: 10.3760/cma.j.cn112137-20230504-00720.

Abstract

To evaluate the effect of compound chamomile and lidocaine hydrochloride gel on oropharyngeal complications after the use of laryngeal mask airway with positive pressure ventilation. A total of 64 patients undergoing elective surgery under general anesthesia using laryngeal mask airway (LMA) with positive pressure ventilation in Beijing Tongren Hospital Affiliated to Capital Medical University From January to March 2023 were prospectively selected and divided into two groups by the random number table method: normal saline group (=32), with 18 males and 14 females, aged 28-64 (48.4±10.6) years, and the compound chamomile and lidocaine hydrochloride gel group (chamomile gel group, =32), with 18 males and 14 females, aged 24-64 (46.3±10.8) years. Patients in both groups received total intravenous anesthesia. Before LMA placement, the front, shoulder and back of LMA were lubricated with normal saline and compound chamomile and lidocaine hydrochloride gel in the normal saline group and the chamomile gel group, respectively. The main outcome measure was the incidence of postoperative oropharyngeal mucosal inflammation at different time points after the removal of the laryngeal mask. Secondary outcome measures included oropharyngeal mucositis score, sore throat score, hoarse voice score, cough score and throat dryness score at different time points after LMA removal, the number of LMA insertion times, time of successful insertion and leakage pressure, as well as stress reactions such as cough and agitation before and after LMA removal, and adverse reactions such as tongue numbness and protective pharyngeal reflex limitation during recovery. The incidence of oropharyngeal mucositis in the chamomile gel group was 25.0% (8/32), 31.3% (10/32), 28.1% (9/32) and 3.1% (1/32) at 0.5, 3, 6 and 24 h after LMA removal, respectively, which were lower than those of normal saline group [53.1% (17/32), 59.4% (19/32), 59.4% (19/32) and 21.9% (7/32)] (all <0.05). The oropharyngeal mucositis scores of patients in the chamomile gel group were 0 (0, 0.8), 0 (0, 1.0), 0 (0, 1.0) and 0 (0, 0) respectively at 0.5, 3, 6 and 24 h after LMA removal, which were lower than those in the saline group [1.0 (1.0, 1.8), 1.0 (0, 2.0), 1.0 (0, 2.0) and 0 (0, 0)] (all <0.05). The cough score of the patients in the chamomile gel group was 0 (0, 0) and 0 (0, 0) at 3, 6 h after LMA removal, which were lower than those of the normal saline group [(0, 0) and 0 (0, 0)] (both <0.05). The throat dryness score of the patients in the chamomile gel group was 0 (0, 1.0) at 3 h after LMA removal, which was lower than that of the normal saline group [1.0 (0.3, 1.0)] (=0.019). The time of successful LMA insertion in the chamomile gel group was 25.0 (20.3, 29.8) s, which was shorter than that in the saline group [29.0 (25.0, 32.0) s] (=0.016). There were no significant differences in the number of LMA insertion, leakage pressure, postoperative sore throat and hoarse voice scores between the two groups (all >0.05). Likewise, there were no stress reactions such as cough and agitation before and after LMA removal, and no adverse reactions such as tongue numbness and limited protective pharyngeal reflex during recovery. Compound chamomile and hydrochloride lidocaine gel can reduce the incidence of postoperative oropharyngeal mucositis, relieve the symptoms of postoperative oropharyngeal mucositis, pharyngeal dryness and cough, and improve the postoperative comfort of patients using the laryngeal mask airway with positive pressure ventilation.

摘要

评估复方洋甘菊利多卡因凝胶对使用喉罩气道行正压通气后口咽并发症的影响。前瞻性选取2023年1月至3月在首都医科大学附属北京同仁医院择期行全身麻醉、使用喉罩气道(LMA)行正压通气的64例患者,采用随机数字表法分为两组:生理盐水组(n = 32),男18例,女14例,年龄28 - 64岁(48.4±10.6)岁;复方洋甘菊利多卡因凝胶组(洋甘菊凝胶组,n = 32),男18例,女14例,年龄24 - 64岁(46.3±10.8)岁。两组患者均采用全静脉麻醉。在放置LMA前,生理盐水组用生理盐水、洋甘菊凝胶组用复方洋甘菊利多卡因凝胶分别润滑LMA的前端、肩部和后端。主要观察指标为拔除喉罩后不同时间点口咽黏膜炎症的发生率。次要观察指标包括拔除LMA后不同时间点的口咽黏膜炎评分、咽痛评分、声音嘶哑评分、咳嗽评分及咽干评分,LMA插入次数、成功插入时间及漏气压力,以及拔除LMA前后的咳嗽、躁动等应激反应,恢复过程中的舌麻木、咽反射受限等不良反应。洋甘菊凝胶组拔除LMA后0.5、3、6及24 h口咽黏膜炎发生率分别为25.0%(8/32)、31.3%(10/32)、28.1%(9/32)及3.1%(1/32),低于生理盐水组[53.1%(17/32)、59.4%(19/32)、59.4%(19/32)及21.9%(7/32)](均P<0.05)。洋甘菊凝胶组患者拔除LMA后0.5、3、6及24 h口咽黏膜炎评分分别为0(0,0.8)、0(0,1.0)、0(0,1.0)及0(0,0),低于生理盐水组[1.0(1.0,1.8)、1.0(0,2.0)、1.0(0,2.0)及0(0,0)](均P<0.05)。洋甘菊凝胶组患者拔除LMA后3、6 h咳嗽评分为0(0,0)及0(0,0),低于生理盐水组[(0,0)及0(0,0)](均P<0.05)。洋甘菊凝胶组患者拔除LMA后3 h咽干评分为0(0,1.0),低于生理盐水组[1.0(0.3,1.0)](P = 0.019)。洋甘菊凝胶组LMA成功插入时间为25.0(20.3,29.8)s,短于生理盐水组[29.0(25.0,32.0)s](P = 0.016)。两组LMA插入次数、漏气压力、术后咽痛及声音嘶哑评分比较,差异均无统计学意义(均P>0.05)。同样,两组拔除LMA前后均无咳嗽、躁动等应激反应,恢复过程中均无舌麻木、咽反射受限等不良反应。复方洋甘菊利多卡因凝胶可降低使用喉罩气道行正压通气患者术后口咽黏膜炎的发生率,减轻术后口咽黏膜炎、咽干及咳嗽症状,提高患者术后舒适度。

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