【罂粟摘要】应用六种局部药物预防气管插管术后咽喉痛的疗效比较:一项系统评价和网状Meta分析
贵州医科大学 麻醉与心脏电生理课题组
翻译：潘志军 编辑：潘志军 审校：曹莹
通常用于防治气管插管术后咽喉痛(POST)的局部药物包括非甾体抗炎药(NSAIDs)、皮质类固醇、利多卡因、甘草(licorice)和N-甲基-d-天冬氨酸(NMDA)受体拮抗剂(包括氯胺酮和镁)。然而，最佳的预防药物仍然难以捉摸。
我们检索了于2019年9月8日之前发表在PubMed、Embase、科学网和Cochrane图书馆的相关文献。纳入标准为POST患者进行局部预防性药物治疗的随机对照试验(RCTs)。建议评估、发展和评价（等级）系统的分级用于评估证据质量。主要的结局指标是发生术后咽喉痛的风险。我们结合直接和间接证据进行了一项网状Meta分析，以评估局部药物与优选概率排名曲线（SUCRA）下疗效的比值比（ORs）。本研究注册于PROSPERO，编号CRD42020158985。
本研究最终纳入了62项随机对照试验(其中至少73%为双盲)，共包括6708名受试者，并对6类药物和/或安慰剂进行了比较。除利多卡因外，所有预防性干预措施在4个时间间隔内都比安慰剂更有效。利多卡因(OR: 0.35，95%可信区间[CrI]，0.16-0.79)在术后仅2-3小时的时间间隔内比安慰剂具有更好的术后预防干预效果。相对于利多卡因，以下治疗除2-3小时外的POST风险较低:皮质类固醇、氯胺酮、镁、非甾体抗炎药和甘草。这里研究的NMDA受体拮抗剂包括氯胺酮和镁。在术后/拔管后24小时，镁通常显示出比氯胺酮更大的益处(OR: 0.41，95% CrI，0.18-0.92)。与氯胺酮相比，皮质类固醇与在4-6小时(OR: 0.40，95% CrI，0.19-0.83)和24小时(OR: 0.34，95% CrI，0.16-0.72)时间间隔内的POST风险降低相关。在2-3小时的时间间隔内，甘草(OR: 0.38，95% CrI，0.15-0.97)比镁更有效。
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抗疫
我们的分析表明，在所研究的6种局部药物中，利多卡因并不是预防POST的最佳药物。甘草甜素、皮质类固醇、非甾体抗炎药和NMDA受体拮抗剂(氯胺酮和镁)与所研究的4个手术后时间间隔的术后咽部疼痛减轻相关，所有这些药物都可以根据麻醉医生的临床经验和患者偏好进行选择，并推荐用于减轻术后咽喉疼痛。
Ge Wang, Yang Qi, LiNa Wu, et al. Comparative Efficacy of 6 Topical Pharmacological Agents for Preventive Interventions of Postoperative Sore Throat After Tracheal Intubation: A Systematic Review and Network Meta-analysis[J]. (Anesth Analg 2021;133:58–67).
Comparative Efficacy of 6 Topical Pharmacological Agents for Preventive Interventions of Postoperative Sore Throat After Tracheal Intubation: A Systematic Review and Network Meta-analysis
Abstract
Background: Topical pharmacological agents typically used to treat postoperative sore throat (POST) after tracheal intubation include nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, lidocaine, Glycyrrhiza (licorice), and N-methyl-d-aspartate (NMDA) receptor antagonists (including ketamine and magnesium). However, the optimal prophylactic drug remains elusive.
Methods: The literature published before September 8, 2019 was searched on the PubMed, the Embase, the Web of Science, and the Cochrane Library. Randomized controlled trials (RCTs) covering topical prophylactic medications for patients with POST were included. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to assess the quality of evidence. The primary outcome is the risk of POST . Combining both direct and indirect evidence, a network meta-analysis was performed to assess odds ratios (ORs) between the topical pharmacological agents and surface under the cumulative ranking (SUCRA) curve for the treatment-based outcomes. This study is registered with PROSPERO, number CRD42020158985.
Results: Sixty-two RCTs (at least 73% of which were double blinded) that included a total of 6708 subjects and compared 6 categories of drugs and/or placebos were ultimately enrolled. All preventive interventions except lidocaine were more effective than placebo at the 4 time intervals. Lidocaine (OR: 0.35, 95% credible interval [CrI], 0.16-0.79) has a greater POST preventative intervention effect than the placebo at a time interval of only 2 to 3 hours after surgery. Relative to lidocaine, the risk of POST except 2 to 3 hours was lower for the following treatments: corticosteroids, ketamine, magnesium, NSAIDs, and Glycyrrhiza. The NMDA receptor antagonists studied here included ketamine and magnesium. Magnesium generally demonstrated greater benefit than ketamine at 24 hours postsurgery/extubation (OR: 0.41, 95% CrI, 0.18-0.92). Compared with ketamine, corticosteroids were associated with a reduced risk of POST during the 4 to 6 hours (OR: 0.40, 95% CrI, 0.19-0.83) and 24 hours (OR: 0.34, 95% CrI, 0.16-0.72) time intervals. During the 2 to 3 hours time interval,
Glycyrrhiza (OR: 0.38, 95% CrI, 0.15-0.97) was more efficacious than magnesium.
Conclusions: Our analysis shows that, among the 6 topical medications studied, lidocaine is not optimal for topical use to prevent POST . Glycyrrhizin, corticosteroids, NSAIDs, and NMDA receptor antagonists (ketamine and magnesium) are associated with a reduced postoperative pharyngeal pain across the 4 postsurgical time intervals studied, all of which can be chosen according to the clinical experience of the anesthesiologists and the patient preferences and are recommended for the reduction of postoperative throat pain.
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