Improvement effect of budesonide suspension for aerosol inhalation combined with dyclonine mucilage smearing with tracheal catheter on pharyngeal discomfort in patients undergoing gynecological laparoscopic surgery and tracheal intubation under general anesthesia

doi:10.3877/cma.j.issn.1673-5250.2023.04.014

Objective

To explore the improvement effect of budesonide suspension for aerosol inhalation combined with dyclonine mucilage smearing with tracheal catheter on pharyngeal discomfort in patients undergoing gynecological laparoscopic surgery and tracheal intubation under general anesthesia.

Methods

A total of 200 patients undergoing tracheal intubation under general anesthesia during gynecological laparoscopy in the People′s Hospital of Luzhai were enrolled as the research objects from January 2021 to January 2023. According to random number table method, they were divided into observation group (n=100, budesonide suspension for aerosol inhalation combined with dyclonine mucilage smearing with tracheal catheter) and control group (n=100, dyclonine mucilage smearing with tracheal catheter). By prospective research methods, the operation time, tracheal intubation time and occurrence of pharyngeal discomfort after extubation in both groups were observed. Immediately after extubation (T0), and at 1, 6, 24, 48 and 72 h after extubation (T1, T6, T24, T48, T72), pharyngeal symptoms (sore throat, foreign body sensation in throat, hoarseness) were scored by visual analogue scale (VAS). The mucosal responses of pharynx and larynx were evaluated by scores of the World Health Organization (WHO) pharyngeal and laryngeal mucosal responses. The scores of pharyngeal and laryngeal mucosal responses of two groups at the 6 time points (T0, T1, T6, T24, T48, T72) were compared by double-factor repeated measure ANOVA. The intra-group and inter-group comparison of VAS scores of three kinds of throat symptoms in two groups at the 6 time points were conducted by Mann-Whitney U test. This study was approved by the Ethics Committee of the People′s Hospital of Luzhai (Approval No. 202012KD002). Patients and their families gave informed consent to the treatment and signed informed consent forms.

Results

① There were no significant differences in VAS scores of sore throat and hoarseness between two groups at T0 (P>0.05). The VAS score of pharyngeal foreign body sensation at T0 in observation group was lower than that in control group, and the difference was statistically significant (P<0.05). ② The VAS scores of sore throat, foreign body sensation in throat and hoarseness at T1, T6, T24, T48 and T72 in observation group were lower than those in control group, respectively, and the differences were statistically significant (all with P<0.05). ③ There were significant differences in inter-group comparison of VAS scores of three kinds of throat symptoms at T0, T1, T6, T24, T48 and T72 in observation group, respectively, (all with P<0.001), which were the same in control group. ④ There were significant differences in scores of pharyngeal and laryngeal mucosal response of two groups at T0, T1, T6, T24, T48 and T72, including inter-group principal effect, inter-group with time interaction effect and time principal effect (F_inter-group=626.46, P<0.001; F_{inter-group × time}=12.02, P<0.001; F_time=436.81, P<0.001). ⑤ The incidence of pharyngeal discomfort in observation group was lower than that in control group, and the difference was statistically significant (22.0% vs 39.0%, χ²=6.82, P=0.009).

Conclusions

Budesonide suspension for aerosol inhalation combined with dyclonine mucilage smearing with tracheal catheter can reduce pharyngeal discomfort in patients undergoing tracheal intubation under general anesthesia during gynecological laparoscopy surgery.

Key words: Budesonide, Dyclonine, Gynecologic surgery, Laparoscopy, Intubation, intratracheal, Anesthesia, general, Pharyngeal discomfort

表1 2组接受妇科腹腔镜手术患者临床资料比较

组别	例数	年龄(岁，±s)	ASA分级[例数(%)]		身高(m，±s)	体重(kg，±s)	手术时间(min，±s)	气管导管带管时间(min，±s)
组别	例数	年龄(岁，±s)	Ⅰ级	Ⅱ级	身高(m，±s)	体重(kg，±s)	手术时间(min，±s)	气管导管带管时间(min，±s)
观察组	100	36.4±8.3	69(69.0)	31(31.0)	1.61±0.12	58.2±8.4	160.5±12.6	72.7±16.3
对照组	100	35.5±8.2	73(73.0)	27(27.0)	1.59±0.15	57.1±8.3	158.2±13.2	77.1±15.3
统计量		t＝0.77	χ²＝0.39		t＝1.04	t＝1.01	t＝1.28	t＝1.96
P值		0.445	0.533		0.299	0.313	0.203	0.052

表1 2组接受妇科腹腔镜手术患者临床资料比较

组别	例数	年龄(岁，±s)	ASA分级[例数(%)]		身高(m，±s)	体重(kg，±s)	手术时间(min，±s)	气管导管带管时间(min，±s)
组别	例数	年龄(岁，±s)	Ⅰ级	Ⅱ级	身高(m，±s)	体重(kg，±s)	手术时间(min，±s)	气管导管带管时间(min，±s)
观察组	100	36.4±8.3	69(69.0)	31(31.0)	1.61±0.12	58.2±8.4	160.5±12.6	72.7±16.3
对照组	100	35.5±8.2	73(73.0)	27(27.0)	1.59±0.15	57.1±8.3	158.2±13.2	77.1±15.3
统计量		t＝0.77	χ²＝0.39		t＝1.04	t＝1.01	t＝1.28	t＝1.96
P值		0.445	0.533		0.299	0.313	0.203	0.052

表2 2组接受妇科腹腔镜手术患者拔管后不同时间点咽喉痛症状VAS评分组内及组间比较[分，M(Q₁，Q₃)]

组别	例数	T0	T1	T6	T24	T48	T72	Z值	P值
观察组	100	1(1，2)	1(1，2)^ab	1(0，1)	0(0，1)^c	0(0，1)^abcd	0(0，1)^abcde	236.48	<0.001
对照组	100	1(1，2)	1(1，2)^a	1(1，2)^ab	1(1，1)^abc	1(0，1)^abcd	0(0，1)^abcde	181.28	<0.001
Z值		0.74	16.05	46.14	31.31	15.18	14.58
P值		0.391	<0.001	<0.001	<0.001	<0.001	<0.001

表2 2组接受妇科腹腔镜手术患者拔管后不同时间点咽喉痛症状VAS评分组内及组间比较[分，M(Q₁，Q₃)]

组别	例数	T0	T1	T6	T24	T48	T72	Z值	P值
观察组	100	1(1，2)	1(1，2)^ab	1(0，1)	0(0，1)^c	0(0，1)^abcd	0(0，1)^abcde	236.48	<0.001
对照组	100	1(1，2)	1(1，2)^a	1(1，2)^ab	1(1，1)^abc	1(0，1)^abcd	0(0，1)^abcde	181.28	<0.001
Z值		0.74	16.05	46.14	31.31	15.18	14.58
P值		0.391	<0.001	<0.001	<0.001	<0.001	<0.001

表3 2组接受妇科腹腔镜手术患者拔管后不同时间点咽喉部异物感VAS评分组内及组间比较[分，M(Q₁，Q₃)]

组别	例数	T0	T1	T6	T24	T48	T72	Z值	P值
观察组	100	1(0，2)	1(0，2)^a	0(0，1)^ab	0(0，1)^abc	0(0，1)^abcd	0(0，1)^abcde	297.62	<0.001
对照组	100	1(1，2)	1(0，2)^a	1(0，1)^ab	1(0，1)^abc	0(0，1)^abcd	0(0，1)^abcde	201.49	<0.001
Z值		5.61	4.67	14.17	14.68	20.45	29.50
P值		0.018	0.031	<0.001	<0.001	<0.001	<0.001

表3 2组接受妇科腹腔镜手术患者拔管后不同时间点咽喉部异物感VAS评分组内及组间比较[分，M(Q₁，Q₃)]

组别	例数	T0	T1	T6	T24	T48	T72	Z值	P值
观察组	100	1(0，2)	1(0，2)^a	0(0，1)^ab	0(0，1)^abc	0(0，1)^abcd	0(0，1)^abcde	297.62	<0.001
对照组	100	1(1，2)	1(0，2)^a	1(0，1)^ab	1(0，1)^abc	0(0，1)^abcd	0(0，1)^abcde	201.49	<0.001
Z值		5.61	4.67	14.17	14.68	20.45	29.50
P值		0.018	0.031	<0.001	<0.001	<0.001	<0.001

表4 2组接受妇科腹腔镜手术患者拔管后不同时间点声嘶VAS评分组内及组间比较[分，M(Q₁，Q₃)]

组别	例数	T0	T1	T6	T24	T48	T72	Z值	P值
观察组	100	1(1，2)	0(0，2)^a	0(0，1)^ab	0(0，1)^abc	0(0，1)^abcd	0(0，0)^abcde	243.18	<0.001
对照组	100	1(1，2)	1(0，2)^a	1(0，2)^ab	0(0，1)^abc	0(0，1)^abcd	0(0，1)^abcde	184.66	<0.001
Z值		1.28	15.36	19.36	22.62	35.18	12.77
P值		0.259	<0.001	<0.001	<0.001	<0.001	<0.001

表4 2组接受妇科腹腔镜手术患者拔管后不同时间点声嘶VAS评分组内及组间比较[分，M(Q₁，Q₃)]

组别	例数	T0	T1	T6	T24	T48	T72	Z值	P值
观察组	100	1(1，2)	0(0，2)^a	0(0，1)^ab	0(0，1)^abc	0(0，1)^abcd	0(0，0)^abcde	243.18	<0.001
对照组	100	1(1，2)	1(0，2)^a	1(0，2)^ab	0(0，1)^abc	0(0，1)^abcd	0(0，1)^abcde	184.66	<0.001
Z值		1.28	15.36	19.36	22.62	35.18	12.77
P值		0.259	<0.001	<0.001	<0.001	<0.001	<0.001

表5 2组接受妇科腹腔镜手术患者拔管后不同时间点咽、喉黏膜反应评分比较(分，±s)

组别	例数	T0	T1	T6	T24	T48	T72	F值	P值
观察组	100	3.5±1.3	3.2±1.0	3.0±0.8^ab	2.6±0.4^abc	0.96±0.26^abcd	0.52±0.08^abcde	357.92	<0.001
对照组	100	5.7±1.9	4.6±1.4^a	4.3±1.1^ab	3.8±0.7^abc	2.31±0.42^abcd	1.36±0.25^abcde	235.53	<0.001
t值		16.53	15.64	14.02	7.08	4.21	3.47
P值		<0.001	<0.001	<0.001	<0.001	<0.001	<0.001

表5 2组接受妇科腹腔镜手术患者拔管后不同时间点咽、喉黏膜反应评分比较(分，±s)

组别	例数	T0	T1	T6	T24	T48	T72	F值	P值
观察组	100	3.5±1.3	3.2±1.0	3.0±0.8^ab	2.6±0.4^abc	0.96±0.26^abcd	0.52±0.08^abcde	357.92	<0.001
对照组	100	5.7±1.9	4.6±1.4^a	4.3±1.1^ab	3.8±0.7^abc	2.31±0.42^abcd	1.36±0.25^abcde	235.53	<0.001
t值		16.53	15.64	14.02	7.08	4.21	3.47
P值		<0.001	<0.001	<0.001	<0.001	<0.001	<0.001

[3]	Chang JE, Min SW, Kim CS, et al. Effect of prophylactic benzydamine hydrochloride on postoperative sore throat and hoarseness after tracheal intubation using a double-lumen endobronchial tube: a randomized controlled trial[J]. Can J Anesth, 2015, 62(10): 1097-1103. DOI: 10.1007/s12630-015-0432-x.
[4]	刘健慧，郁庆，张晓庆，等. 控制气管导管套囊压力对全麻手术患者气管插管相关性并发症的影响：前瞻性、多中心、随机、双盲研究[J]. 中华麻醉学杂志，2010, 30(5): 521-523. DOI: 10.3760/cma.j.issn.0254-1416.2010.05.003.
[5]	吴丽颖，张运好，刘建芳，等. 替硝唑、达克罗宁和氯己定在大鼠体内的毒代动力学及组织分布研究[J]. 药物分析杂志，2016, 36(1): 102-110. DOI: 10.16155/j.0254-1793.2016.01.16.
[6]	Chen JM, Li DD, Chen YS, et al. The effectiveness of electro-acupuncture combined with dyclonine hydrochloride in relieving the side effects of gastroscopy: a controlled trial[J]. Ann Palliat Med, 2021, 10(3): 2958-2970. DOI: 10.21037/apm-20-831.
[7]	Wang N, Jin F, Liu W, et al. 1% Tetracaine hydrochloride injection pure solution aerosol inhalation combined with oral administration of dyclonine hydrochloride mucilage as upper airway anesthesia for bronchoscopy: a randomized controlled trial[J]. Clin Respir J, 2020, 14(2): 132-139. DOI: 10.1111/crj.13110.
[8]	叶爱素，郑凤燕，林卫红，等. 早期雾化对患者双腔支气管插管术后咽喉痛的影响[J]. 实用医学杂志，2016, 32(14): 2405-2407. DOI: 10.3969/j.issn.1006-5725.2016.14.047.
[9]	Lee J, Park HP, Jeong MH, et al. Combined intraoperative paracetamol and preoperative dexamethasone reduces postoperative sore throat: a prospective randomized study[J]. J Anesth, 2017, 31(6): 869-877. DOI: 10.1007/s00540-017-2411-6.
[10]	Boonstra AM, Schiphorst Preuper HR, Reneman MF, et al. Reliability and validity of the visual analogue scale for disability in patients with chronic musculoskeletal pain[J]. Int J Rehabil Res, 2008, 31(2): 165-169. DOI: 10.1097/MRR.0b013e3282fc0f93.
[11]	叶太财，周良军，曹强，等. 达克罗宁胶浆对全麻患者在Pentax AWS-S200视频喉镜插管与PACU拔管期间应激反应的影响[J]. 广东医学，2016, 37(12): 1785-1788. DOI: 10.13820/j.cnki.gdyx.20160706.008.
[12]	谭惠莲，梁玉琨，黎勇明，等. 气管插管全麻行全子宫切除术后患者服用罗汉果煎剂对咽喉部并发症影响的效果观察[J]. 护士进修杂志，2018, 33(24): 2259-2262. DOI: 10.16821/j.cnki.hsjx.2018.24.015.
[13]	张少华，杨木泽，张昌盛，等. 盐酸达克罗宁胶浆用于门诊消化内镜手术全麻插管时的表面麻醉效果[J]. 武警医学，2021, 32(9): 758-761. DOI: 10.14010/j.cnki.wjyx.2021.09.005.
[14]	张宁丽，屈启才，柴璇，等. 比较盐酸达克罗宁胶浆及利多卡因凝胶作为喉罩润滑剂的临床分析[J]. 昆明医科大学学报，2019, 40(2): 102-105. DOI: 10.3969/j.issn.1003-4706.2019.02.021.
[15]	骆喜宝，庾俊雄，管飞杰，等. 双腔支气管导管热软化并涂抹达克罗宁对全身麻醉胸科手术患者插管期和拔管期心血管和咽喉部反应的影响[J]. 广西医学，2019, 41(7): 816-818. DOI: 10.11675/j.issn.0253-4304.2019.07.05.
[16]	陈琪，钟雪娇，胡开红，等. 拔管即刻布地奈德低温雾化吸入对双腔气管导管插管后咽部并发症的影响[J]. 实用医学杂志，2018, 34(12): 2065-2069. DOI: 10.3969/j.issn.1006-5725.2018.12.036.
[17]	程蕾，张科研，句敏. 早期联合应用布地奈德和利多卡因雾化吸入减轻甲状腺术后全身麻醉插管导致的咽痛[J]. 中国医科大学学报，2019, 48(4): 367-369. DOI: 10.12007/j.issn.0258-4646.2019.04.018.
[18]	刘慧琳，李磊，马青变. 甲基强的松龙联合布地奈德雾化预防气管插管拔管后咽喉部不适的临床观察[J]. 中华老年医学杂志，2013, 32(10): 1055-1057. DOI: 10.3760/cma.j.issn.0254-9026.2013.10.008.
[19]	曲海霞，李洁. 利多卡因联合布地奈德雾化吸入对双腔支气管插管患者术后咽喉痛的影响[J]. 中国药物与临床，2020, 20(22): 3777-3779. DOI: 10.11655/zgywylc2020.22.028.
[1]	包丽，曲鸣宇，肖昭扬. 气管插管全麻术后咽喉部相关并发症的研究进展[J]. 临床麻醉学杂志，2018, 34(5): 501-504. DOI: 10.12089/jca.2018.05.021.
[2]	岳红红，高寅秋，董锡臣，等. 电针防治气管插管全麻胃肠术后咽喉痛及恶心呕吐的随机对照研究[J]. 针刺研究，2021, 46(2): 164-167. DOI: 10.13702/j.1000-0607.200464.

[1]	Chengcai Yao, Changchun Liu, Wenjian Huang, Ming Chen. Single-port non-lipolysis fluorescence-guided laparoscopy for axillary lymph node biopsy in early breast cancer[J]. Chinese Journal of Breast Disease(Electronic Edition), 2023, 17(05): 266-271.
[2]	Li Dai, Huiwei Deng, Huajing Guo, Furong Huang. Effect of continuous infusion of esketamine on postoperative sleep quality of patients undergoing laparoscopic colorectal cancer surgery[J]. Chinese Archives of General Surgery(Electronic Edition), 2023, 17(06): 408-412.
[3]	Di Cao, Yuru Zhang. A case of pelvic floor hernia repaired by laparoscopic biological patch after radical resection of rectal cancer[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(01): 115-116.
[4]	Kai Li, Lin Chen, Han Xiang, Huaidong Su, Wei Zhang. Clinical application of a U-shaped memory alloy wire in transumbilical single-port laparoscopic appendectomy[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(01): 15-15.
[5]	Mingchao Yi, Xin Wang, Han Xiang, Huaidong Su, Wei Zhang. Clinical application of a T-type memory wire in transumbilical single-hole laparoscopic cholecystectomy[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2023, 17(06): 599-599.
[6]	Mingchao Yi, Xin Wang, Han Xiang, Huaidong Su, Wei Zhang. Clinical application of a T-type memory wire in transumbilical single-hole laparoscopic cholecystectomy[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2023, 17(06): 599-599.
[7]	Feilong Meng, Shuai Hua, Ying Zhang, Guanghai Lu. Application of transumbilical single-port laparoscopic retrosheath approach in total extraperitoneal inguinal hernia repair[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2023, 17(06): 658-660.
[8]	Tao Ma, Chunwei Ye, Tao Liu, Wenxi Peng, Zhipeng Li. Comparison of laparoscopic and open disconnected pyeloplasty in the treatment of ureteropelvic junction obstruction in children[J]. Chinese Journal of Endourology(Electronic Edition), 2023, 17(06): 605-610.
[9]	Cheng Liu, Cong Lai, Jian Huang, Jianchen Wang, Xiyun Luo, Kewei Xu. Feasibility study of EDGE SP1000 single hole surgical robot assisted laparoscopic partial ureterectomy with end-to-end anastomosis in pigs[J]. Chinese Journal of Endourology(Electronic Edition), 2023, 17(06): 642-646.
[10]	Jiahui Zhao, Yongxing Wang, Tao Peng, Mingchuan Li, Dechao Wei, Yili Han, Zhu Hou, Yongguang Jiang, Yong Luo. Risk factors of prolonged operation time and higher intraoperative blood loss in retroperitoneal laparoscopic radical nephrectomy[J]. Chinese Journal of Endourology(Electronic Edition), 2023, 17(06): 575-580.
[11]	Bangqi Wang, Bote Chen, Haojian Lin, Huiyang Xu, Zhenwei Wang, Xuefeng Yuan, Kangjian Lin, Xiaofu Qiu. Application of laparoscopic pyeloplasty combined with ureteroscopy in the treatment of ureteropelvic junction obstruction complicated with calyx calculi[J]. Chinese Journal of Endourology(Electronic Edition), 2023, 17(06): 597-600.
[12]	Ming Zhu, Guoyu Tong, Haiteng Zhao, Liang Zhong, Xiangyu Zou, Shaofeng Wu, Yinan Zhang. Clinical significance of laparoscopic technique in reducing secondary surgery of occult inguinal hernia and hydrocele of children[J]. Chinese Journal of Endourology(Electronic Edition), 2023, 17(05): 457-460.
[13]	Cai Chen, Feng Yuan, Lu Jin, Qiu Yao, Boxin Xue, Xiaolong Liu. Exploration of laparoscopic decortication of simple renal cysts in day surgery[J]. Chinese Journal of Endourology(Electronic Edition), 2023, 17(05): 466-469.
[14]	Yonghui Peng, Wenjie Zhang, Binggen Li, Xiangyang Nie, Kai Wu, Liucheng Yang. Clinical application of high ligation of single hole and double needle hernia sac in giant inguinal hernia in children[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2023, 17(05): 566-569.
[15]	Xin Tang, Dechang Diao, Weilin Liao, Jiaxin Lin, Jiahao Wang, Wenjuan Li, Jiaxin Xie, Lin Ao, Hongming Li, Xiaojiang Yi, Xinquan Lu, Xiaochuang Feng. Short-term and long-term outcomes of nerve-sparing sheath outside-sheath separation technique in D3 radical resection for right-sided colon cancer under laparoscope: A retrospective cohort study based on propensity score matching[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2023, 12(05): 372-380.

Viewed

Full text

Abstract

Please choose a citation manager

Content to export