全麻下经鼻气管插管和喉罩通气对儿童术后不适及苏醒期谵妄的对比研究
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Postoperative discomfort and emergence delirium in children undergoing dental rehabilitation under general anesthesia: comparison of nasal tracheal intubation and laryngeal mask airway
背景与目的
研究表明全身麻醉气管内插管副作用较常见，如：喉痛、发声困难及术后恶心呕吐（PONV）。喉罩插管（LMAW）被认为可减少这些副作用。本试验旨在探讨LMAW或气管插管（NTI）对患者术后不适、出现谵妄和恢复时间的影响。
方 法
本研究为前瞻性随机试验。选取70例患儿（3-7岁）全身麻醉下行牙科手术，随机分成鼻插管组（35例）和喉罩组（35例）。术后即刻，术后1小时，术后6小时记录喉部疼痛，牙齿疼痛，发声困难，术后恶心呕吐，苏醒时间，苏醒期谵妄评分并以Wong-Baker面部表情量表，发声困难评分，儿童麻醉苏醒谵妄评分量表（PAEDS）进行评分记录。
结 果
术后即刻，术后1小时，术后6小时的喉部疼痛评分明显高于喉罩组,分别为(97.2% vs.8.5% ,P=0.00),(94.2% vs. 0%,p=0.00)和(25.7% vs. 0%,P=0.00)。两组之间存在明显差异。两组术后牙齿疼痛评分无明显差别(P>0.05)。插管组在术后即刻，术后1小时，术后6小时的发声困难发生率明显高于喉罩组，分别为(91.4% vs. 14.2%， P=0.00), (45.7% vs. 5.7%, P=0.00), (34.2% vs. 2.8%, P=0.00).
结 论
与气管插管相比，喉罩患者术后不适度更低，恢复时间更快等，并且不影响医生的手术操作，可作为全麻下儿童牙科手术气道管理的一种可选方案。
原始文献摘要
Keles S, Kocaturk O. Postoperative discomfort and emergence delirium in children undergoing dental rehabilitation under general anesthesia: comparison of nasal tracheal intubation and laryngeal mask airway. J Pain Res. 2018; 11: 103-110.
Background: Several studies have identified side effects of general anesthesia with endotracheal intubation, such as laryngeal pain, dysphonia, and postoperative nausea and vomiting (PONV). The laryngeal mask airway (LMAw) is believed to decrease these side effects. The aim of this trial was to compare postoperative discomfort, emergence delirium, and recovery time of patients who received either an LMAw or nasotracheal intubation (NTI).
Patients and methods: A total of 70 children were randomly assigned to the LMAw group (n=35) or the NTI group (n=35). Both groups underwent mask induction with 8% sevoflurane. The NTI group received muscle relaxant, whereas the LMAw group did not. Postoperative laryngeal pain, dental pain, dysphonia, and PONV were assessed immediately and at 1 hour and 6 hours postoperatively. The Wong–Baker Faces Scale was used to evaluate the patients’ self-reported pain. In addition, decayed, missing, and filled teeth (dft/DMFT) values, dental procedure type, number of dental procedures, duration of the dental operation, duration of anesthesia, recovery time, emergence delirium, pediatric dentist’s access to the mouth, and parents’ satisfaction levels were recorded. Data were analyzed using descriptive statistics, chisquare tests, and two-sample t-tests.
Results: The incidence of postoperative laryngeal pain was significantly higher in the NTI group immediately (97.2% vs. 8.5%, P=0.00), 1 hour (94.2% vs. 0%, P=0.00), and 6 hours postoperatively (25.7% vs. 0%, P=0.00). There were no statistically significant differences between the two groups in dental pain scores, dft/DMFT values, duration of anesthesia, duration of the dental operation, number of dental procedures, the incidence of PONV, or pediatric dentist’s access to the mouth (P>0.05).Emergence delirium and recovery time were significantly higher in the NTI group (P<0.05).
Conclusion: The LMAw provided a more comfortable postoperative period than NTI for children who underwent full-mouth dental rehabilitation under general anesthesia.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：王贵龙 编辑：何幼芹 审校：李华宇