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护理学报 ›› 2022, Vol. 29 ›› Issue (23): 33-38.doi: 10.16460/j.issn1008-9969.2022.23.033

• 循证护理 • 上一篇    下一篇

气管插管患者术后咽喉痛围术期防治策略的循证实践

卓眉秀a, 王宜庭b, 刘倩b, 朱丽群c, 包磊b, 吴进b, 殷娜d   

  1. 江苏大学附属医院 a.妇科; b.麻醉手术室; c.护理部; d.胸外科,江苏 镇江 212001
  • 收稿日期:2022-07-14 出版日期:2022-12-10 发布日期:2023-01-13
  • 通讯作者: 王宜庭（1989-）,男,江苏镇江人,硕士,主管护师,护士长。E-mail:1047885293@qq.com
  • 作者简介:卓眉秀（1989-）,女,山东枣庄人,硕士,主管护师。
  • 基金资助:
    国家卫生健康委医院管理研究所基金项目（YLZLXZ-2021-007）; 江苏大学临床医学专项基金项目（JDLCHL202006）

Evidence-based Practice of Perioperative Prevention and Treatment Strategies for Postoperative Sore Throat in Patients with Tracheal Intubation

ZHUO Mei-xiua, WANG Yi-tingb, LIU Qianb, ZHU Li-qunc, BAO Leib, WU Jinb, YIN Nad   

  1. a. Dept. of Gynecology; b. Dept. of Anesthesiology and Operating Room; c. Dept. of Nursing Administration; d. Dept. of Thoracic Surgery, Affiliated Hospital of Jiangsu University, Zhenjiang 212001, China
  • Received:2022-07-14 Online:2022-12-10 Published:2023-01-13

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摘要： 目的 通过循证护理的方法,建立全身麻醉气管插管后咽喉疼痛的围术期防治策略,为患者康复及舒适化医疗发展提供参考依据。方法 以循证护理方法学为指导,系统检索UpToDate、BMJ、JBI、Cochrane Library、NICE、SIGN、ASA、AORN、RNAO、PubMed、CINAHL、医脉通、中国知网、万方、中国麻醉官网,筛选后共纳入文献18篇,经专人评价提取汇总后形成全身麻醉气管插管后咽喉痛围术期防治策略,并将该策略应用临床。采用前后对照的方式,选取我院2020年9—11月142例患者为对照组,2021年1—2月共121例患者为观察组,比较2组患者拔管后即时、拔管后24 h末术后咽喉痛的严重程度、术后24 h的舒适度及对气管插管患者围术期防治环节中执行规范情况。结果 与对照组相比,观察组患者在拔管后即时及拔管后24 h末术后咽喉痛的严重程度均下降（P<0.05）,患者术后24 h舒适度提升（P<0.05）,对气管插管患者围术期防治环节中执行规范情况得以改善（P<0.05）。结论 基于循证的围术期咽喉疼痛防治策略能降低术后咽喉疼痛严重程度,提高气管插管患者术后舒适度,改善对气管插管患者围术期防治环节中执行规范情况,值得临床借鉴使用。

关键词: 全身麻醉, 气管插管, 麻醉护理, 咽喉疼痛, 循证护理

Abstract: Objective To develop perioperative prevention and treatment strategies for postoperative sore throat in patients with tracheal intubation after general anesthesia through evidence-based nursing, and to provide reference for patient rehabilitation and the development of comfortable medical care. Methods Guided by evidence-based nursing, a systematic search of UpToDate, BMJ, JBI, Cochrane Library, NICE, SIGN, ASA, AORN, RNAO, PubMed, CINAHL, Medlive, CNKI, Wanfang Database, and the official website of China Anesthesia was conducted. Eighteen piece of literature were included after screening. After being evaluated, extracted and summarized, the perioperative prevention and treatment strategies for sore throat in patients after tracheal intubation with general anesthesia were developed, and the strategies were applied in clinical practice. A total of 142 patients in our hospital from September to November 2020 were selected as control group, and another 121 patients from January to February 2021 as observation group. The two groups of patients were compared immediately after extubation and 24 hours after extubation in terms of the severity of postoperative sore throat, the comfort 24 hours after surgery, and the implementation of norms in the perioperative prevention and treatment of tracheal intubation patients. Results Compared with that in the control group, the severity of sore throat in the observation group decreased immediately after extubation and at the end of 24 hours after extubation (P<0.05), and the patients' comfort improved at 24 hours after extubation (P<0.05). The implementation of norms in the perioperative prevention and treatment of tracheal intubation patients was improved (P<0.05). Conclusion Evidence-based perioperative prevention and treatment strategies for postoperative sore throat can reduce the severity of postoperative sore throat, improve postoperative comfort for patients with tracheal intubation, and the implementation of norms in the perioperative prevention and treatment, which is worthy of clinical promotion.

Key words: general anesthesia, tracheal intubation, anesthesia nursing, sore throat, evidence-based nursing

中图分类号: 

  • R473.6
[1] Tosh P, Kadapamannil D, Rajan S, et al.Effect of C-MAC Video Laryngoscope-aided Intubations Using D-Blade on Incidence and Severity of Postoperative Sore Throat[J].Anesth Essays Res,2018,12(1):140-144.DOI:10.4103/aer.AER_182_17.
[2] Rajan S, Malayil GJ,Varghese R,et al.Comparison of Usefulness of Ketamine and Magnesium Sulfate Nebulizations for Attenuating Postoperative Sore Throat,Hoarseness of Voice,and Cough[J].Anesth Essays Res,2017,11(2):287-293.DOI:10.4103/0259-1162.181427.
[3] Kuwamura A, Nobuyasu K, Ryota T, et al.Preoperative Oral Administration of Kikyo-to, Akampo Medicine, Alleviates Postoperative Sore Throat:A Prospective,Double-blind,Randomized Study[J]. J Altern Complement Med, 2016,22(4):294-297. DOI:10.1089/acm.2015.0241.
[4] 戴健如. 术前护理干预对全麻手术患者术后气管拔管的影响[J].护理学报, 2010,17(10A):68-70. DOI:10.3969/j.issn.1006-2084.2018.14.020.
[5] Biro P, Seifert B, Pasch T.Complaints of Sore Throat after Tracheal Intubation: A Prospective Evalution[J]. Eur J Anaesthesiol,2005,22(4):307-311.DOI:10.1017/S0265021505000529.
[6] 刘鑫,江锦芳,覃彦珠,等.鼻咽癌放化疗患者口腔黏膜炎防护策略的循证实践[J].护理学报,2018,25(11):26-30.DOI:10.16460/j.issn1008-9969.2018.11.026.
[7] Das A, Chattoppadhyay, Nandy S, et al.Postoperative Sore Throat Prevention in Ambulatory Surgery: A Comparison between Preoperative Aspirin and Magnesium Sulfate Gargle-a Prospective,Randomized,Double-blind Study[J].Anesth Essays Res,2017,11(1):94. DOI:10.4103/0259-1162.186602.
[8] 张晓敏,杨宁,彭雅雯,等.成年人全身麻醉气管插管POST防治的研究进展[J].国际麻醉学与复苏杂志,2018,39(9):900-904.DOI:10.3760/cma.j.issn.1673-4378.2018.09.019.
[9] Lauren Berkow.Complications of Airway Management in Adults[EB/OL].[2020-07-23].https://upto.cn.nd.goftp.xyz/contents/complications-of-airway-management-in-adults?search=%E2%80%9Csore%20throat%22&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2.
[10] Scott A Falk, Lee A Fleisher.Over View of Anesthesia[EB/OL].[2020-03-16].https://upto.cn.nd.goftp.xyz/contents/zh-Hans/overview-of-anesthesia?search=Overview%20of%20anesthesia&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1.DOI:10.1007/s00101-013-2222-6.
[11] Enterlein G,Byhahn C.Practice Guidelines for Management of the Difficult Airway[J]. Anaesthesist,2013,62(10):832-835.DOI:10.1007/s00101-013-2222-6.
[12] Lundstrom LH, Duez CHV, Norskov AK, et al. Avoidance Versus Use of Neuromuscular Blocking Agents for Improving Conditions during Tracheal Intubation or Direct Laryngoscopy in Adults and Adolescents[J]. Cochrane Database Syst Rev,2017,5(5):CD009237. DOI:10.1007/s12630-019-01396-7.
[13] Kuriyama A,Maeda H,Sun R.Topical Application of Magnesium to Prevent Intubation-related Sore Throat in Adult Surgical Patients:A Aystematic Review and Meta-analysis[J].Can J Anesth, 2019, 66(9):1082-1094.DOI:10.1007/s12630-019-01396-7.
[14] Jiang J, Ma DX, Li B,et al.Videolaryngoscopy Versus Direct Laryngoscopy for Nasotracheal Intubation:A Systematic Review and Meta-analysis of Randomised Controlled Trials[J]. J Clin Anesth,2019,66(9):6-16. DOI:10.1016/j.jclinane.2018.10.025.
[15] Kuriyama A, Maeda H.Topical Application of Licorice for Prevention of Postoperative Sore Throat in Adults A Systematic Review and Meta-analysis[J]. J Clin Anesth,2019,54:25-32.DOI:10.1016/j.jclinane.2018.10.025.
[16] Kuriyama A, Aga M, Maeda H.Topical Benzydamine Hydrochloride for Prevention of Postoperative Sore Throat in Adults Undergoing Tracheal Intubation for Elective Surgery a Systematic Review and Meta-analysis[J]. Anaesthesia,2018,73(7):889-900. DOI:10.1371/journal.pone.0237174.
[17] Yu J, Ren L, Min S,et al.Nebulized Pharmacological Agents for Preventing Postoperative Sore Throat: A Systematic Review and Network Meta-analysis[J].PLOS ONE,2020,15(8):e0237174. DOI:10.1371/journal.pone.0237174.
[18] Zhang W, Zhao G,Li L,et al.Prophylactic Administration of Corticosteroids for Preventing Postoperative Complications Related to Tracheal Intubation A Systematic Review and Meta-analysis of 18 Randomized Controlled Trials[J]. Clin Drug Investig,2016,36(4):255-265.DOI:10.1371/journal.pone.0074467.
[19] Hu B, Bao R,Wang X,et al.The Size of Endotracheal Tube and Sore Throat after Surgery:A Systematic Review and Meta-analysis[J]. PLOS One,2013,8:e74467.DOI:10.1007/s12630-018-01288-2.
[20] Kuriyama A, Maeda H.Preoperative Intravenous Dexamethasone Prevents Tracheal Intubation-related Sore Throat in Adult Surgical Patients a Systematic Review and Meta-analysis[J].Can J Anaesth, 2019,66(5):562-575.DOI:10.23736/S0375-9393.20.14170-1.
[21] Li H, Yue Y, Qu Y,et al.Lidocaine for Postoperative Sore Throat a Meta-analysis of Randomized Controlled Trials[J].Minerva Anestesiol, 2020,86(5):546-553.DOI:10.1111/aas.13553.
[22] Kuriyama A,Nakanishi M,Kamei J,et al.Topical Application of Ketamine to Prevent Postoperative Sore Throat in Adults A systematic Review and Meta-analysis [J]. Acta anaesth Scand,2020,64(5):579-591. DOI:10.1111/aas.13553.
[23] Liu TT, Li L, Wan L,et al.Videolaryngoscopy vs.Macintosh Laryngoscopy for Double-lumen Tube Intubation in Thoracic Surgery: A Systematic Review and Meta-analysis[J].Anaesthesia,2018,73(8):997-1007.DOI:10.1111/anae.14226.
[24] 黎安良,高鸿,林少峰.局部应用倍他米松凝胶预防气管插管术后咽痛的Meta分析[J].国际麻醉学与复苏杂志,2017,38(3):233-237.DOI:10.3760/cma.j.issn.1673-4378.2017.03.009.
[25] 中华医学会呼吸病学分会呼吸治疗学组.人工气道气囊的管理专家共识(草案)[J].中华结核和呼吸杂志,2014,37(11):816-819.DOI:10.3760/cma.j.issn.1001-0939.2014.11.006.
[26] 中华医学会呼吸病学分会呼吸治疗学组.成人气道分泌物的吸引专家共识(草案)[J].中华结核和呼吸杂志,2014,37(11):809-811. DOI:10.3760/cma.j.issn.1001-0939.2014.11.004.
[27] 王春青,胡雁.JBI证据预分级及证据推荐级别系统(2014版)[J].护士进修杂志,2015,30(11):964-967.
[28] 王宜庭,包磊,周英凤,等.全麻气管插管患者术后咽喉疼痛预防最佳证据总结[J].护理学杂志,2021,36(18):82-86. DOI:10.3870/j.issn.1001-4152.2021.18.082.
[29] Levin PD, Chrysostomos C, Ibarra CA,et al.Causes of Sore Throat after Intubation:A Prospective Observational Study of Multiple an Esthesiavariablesiol[J]. Minerva Anestesiol,2017,83(6):582-589.
[30] Lee J Y, Sim WS,Kim ES,et al.Incidence and Risk Factors of Postoperative Sore Throat after Endotracheal Intubation in Korean Patients[J].J Int Med Res,2017,45(2):744-752.DOI:10.1177/0300060516687227.
[31] Lehmann M,Monte K,Barach P,et al.Postoperative Patient Complaints:A Prospective Interview Study of 12,276 Patients[J].J Clin Anesth,2010,22(1):13-21.DOI:10.1016/j.jclinane.2009.02.015.
[32] 王宜庭,时佳琪,蒋鹏,等.成人全麻气管插管患者术后咽喉疼痛预防的证据审查及分析[J].护理学杂志,2021,36(21):3-7.
[33] Kolcaba KY.A Taxonomic Structure for the Toncept Comfort[J].Image J Nure Sch,1991,23(4):237-240. DOI:10.1111/j.1547-5069.1991.tb00678.x.
[34] Kolcaba K, Wilson L.Comfort Care: A Frame Work for Perianesthesia Nursing[J].J Perianesth Nurs,2002,17(2):102-111.DOI:10.1053/jpan.2002.31657.
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