帕瑞昔布钠联合氢化可的松对双腔支气管插管术后咽喉痛的疗效  

Efficacy of parecoxib sodium combined with hydrocortisone on postoperative sore throat caused by double lumen endobronchial intubation

作　　者：何国栋[1] 周日永[1] 杨涛[1] 唐红丽[1] 汪炜健[1] 

机构地区：[1]温州医科大学附属第一医院麻醉科,温州325000

出　　处：《中国临床药学杂志》2016年第4期201-205,共5页Chinese Journal of Clinical Pharmacy

基　　金：浙江省温州市科技计划项目(编号2012S0410)

摘　　要：目的观察帕瑞昔布钠联合氢化可的松对双腔支气管插管患者术后咽喉痛(POST)的临床效果并探讨其可能机制。方法将120例行胸科手术患者随机分为3组:氢化可的松40 mg组(H组)、帕瑞昔布钠40 mg组(P组)、帕瑞昔布钠40 mg+氢化可的松20 mg组(H+P组)。每组40例。诱导后经口明视下插入双腔支气管导管,用纤维支气管镜进行定位。P组和H+P组诱导前分别静脉注射帕瑞昔布钠40 mg,H组和H+P组手术结束前30 min分别静脉注射氢化可的松40和20 mg。记录3组患者双腔管定位时间、手术时间、麻醉时间和术中输入的晶体量和胶体量。用视觉模拟评分法(VAS)评估患者术前及术后6、12、24、48 h咽喉部疼痛程度。术后6 h观察3组患者咳嗽、声嘶、吞咽困难、言语困难的发生率。术后6 h间接喉镜检查患者声门,记录声带充血和声门水肿病例数。于术前、术毕、术后2 h抽取患者静脉血检测血浆IL-6、TNF-α浓度。结果术后6 h H组咽喉部VAS评分高于P组和H+P组,术后12、24 h H组和P组高于H+P组(P<0.05)。术后6 h咳嗽发生率H+P组低于H组和P组(P<0.05)。H组和P组声嘶发生率高于H+P组(P<0.05)。3组患者吞咽困难和言语困难的发生率差异无统计学意义。术后6 h间接喉镜检查发现H+P组声门充血水肿发生率低于H组和P组。术毕、术后2 h 3组患者血浆TNF-α、IL-6与术前相比均有不同程度升高,H组和P组升高程度高于H+P组(P<0.05)。结论帕瑞昔布钠联合氢化可的松通过减轻声带充血水肿和抑制全身炎症反应来明显降低POST的程度,且效果优于单一用药。AIM To observe the effect of parecoxib sodium combined with hydrocortisone on postoperative sore throat （POST） caused by double lumen endobronchial intubation and explore the possible mechanisms. METHODS A total of 120 patients scheduled for thoracic surgery were randomly assigned to 3 groups： hydrocortisone 40 mg group （group H）, parecoxib sodium 40 mg group （group P） and parecoxib sodium 40 mg ＋ hydrocortisone 20 mg group （group H ＋ P） with 40 patients in each group. After induction double lumen tube was inserted through the mouth, the fiber bron- choscope was used to locate the position of double lumen tube. Patients in group P and group H ＋ P were intravenously in- jected with parecoxib sodium 40 mg before induction respectively. Patients in group H and group H ＋ P were intravenous- ly injected with hydroeortisone 40 mg and 20 mg respectively. The double lumen tube positioning time, operative time, anaesthetic time, the volume of crystalloid solution and colloidal solution during operation were recorded. POST was eval- uated with visual analogue scale（VAS） rates of cough, hoarseness, dysphagia before operation, and 6,12,24,48 h after operation individually. The incidence and dysphasia were observed 6 h after surgery. The glottis of all patients was ex-amined by indirect laryngoscopy 6 h after surgery. The cases of vocal congestion and vocal edema were recorded. Venous blood of patients was extracted before surgery and the end of surgery and 2 h after surgery individually to test the concer- tration of IL-6 and TNF-a. RESULTS The VAS sores in group H were higher than those of group P and group H ＋ P 6 h after surgery and the VAS sores in group H and group P were higher than those of group H ＋ P 24 h after surgery（ P 〈 0.05）. The rates of cough in group H ＋ P were lower than those of group H and group P （ P 〈 0.05）. The rates of hoarse- ness in group H and group P were higher than those of group H ＋ P（ P 〈 0.05）. The rates of dysphagia and dysphasia in al

关 键 词：帕瑞昔布钠 氢化可的松 双腔支气管导管 术后咽喉痛 临床疗效 

分 类 号：R614[医药卫生—麻醉学]