Effects of Preoperative Gum Chewing on Sore Throat After General Anesthesia With a Supraglottic Airway Device: A Randomized Controlled Trial
术前咀嚼口香糖对使用声门上气道装置进行全身麻醉术后咽喉痛的影响：一项随机对照试验
论文摘要
BACKGROUND: Postoperative sore throat (POST) is not uncommon after general anesthesia with a supraglottic airway (SGA) device. Although it was reported that some pharmacological and nonpharmacological measures can reduce POST, because of limitations and variable success rates, we need to find a simpler and more effective way to alleviate POST.
背景：使用声门上气道（SGA）装置进行全身麻醉后，术后咽喉痛（POST）并不少见。尽管有报道称一些药物和非药物措施可以减轻术后咽喉痛，但由于其局限性和不同的成功率，我们需要找到一种更简单、更有效的方法来减轻术后咽喉痛。
METHODS: This prospective, observer-blinded, randomized controlled study enrolled 140 patients who required general anesthesia administered via a streamlined liner of the pharyngeal airway (SLIPA) for <60 minutes. They were randomly divided into the gum (group G, n = 70) and control (group C, n = 70) groups. Before the induction of general anesthesia for 5–10 minutes, the patients in group G chewed gum for 2 minutes. Group C was asked to swallow twice without any additional treatment. A standard anesthesia protocol was followed. The incidence and severity of sore throat were assessed up to 24 hours postoperatively. The primary outcome was the incidence of POST numerical rating scale (NRS) scores >3 within 24 hours after surgery, and the secondary outcomes included the POST (NRS) scores 2, 6, and 24 hours after the surgery.
方法：这项前瞻性、观察者盲法随机对照研究招募了 140 名需要通过咽部气道流线型衬垫（SLIPA）进行全身麻醉的患者，麻醉时间小于 60 分钟。他们被随机分为口香糖组（G 组，n = 70）和对照组（C 组，n = 70）。在诱导全身麻醉 5-10 分钟前，G 组患者咀嚼口香糖 2 分钟。C 组要求患者吞咽两次，不做任何额外处理。麻醉过程按照标准方案进行。对术后 24 小时内咽喉疼痛的发生率和严重程度进行评估。主要结果是术后24小时内POST数字评分量表（NRS）评分>3的发生率，次要结果包括术后2、6和24小时的POST（NRS）评分。
RESULTS: The incidence of moderate/severe POST (NRS >3) within 24 hours after surgery was significantly lower in group G (10.1%, 7/69) than in group C (40.6%, 28/69) (odds ratio 0.386, 95% confidence interval [CI], 0.153–0.976; P = .044). The median (interquartile range [range]) scores at 2, 6, and 24 hours after anesthesia in group G were lower than those in the control group at the same times (2 hours: 0 [0–3 {0–4}] vs 3 [0–3 {0–6}], P = .048; 6 hours: 0 [0–3 {0–6}] vs 2 [0–4 {0–6}], P = .048; 24 hours: 0 [0–1 {0–7}] vs 0 [0–2 {0–6}]; P = .011). There were 14 patients (20.3%, 14/69) in group G who had blood stains on the SGA device, which was significantly lower than the number in group C (37.7%, 26/69) (P = .024). In patients with bloody SGA devices, the incidence of POST scores >3 was significantly lower in group G (14.3%, 2/14) than in group C (73.1%, 19/26) (P < .001), while there was no significant difference between the 2 groups in the incidence of POST score >3 in patients without bloody SGA devices (group G: 9.1%, 5/55; group C: 20.9%, 9/43; P = .145).
结果：术后 24 小时内中度/重度 POST（NRS >3）的发生率在 G 组（10.1%，7/69）显著低于C组（40.6%，28/69）（几率比 0.386，95% 置信区间 [CI]，0.153-0.976；P = 0.044）。G组在麻醉后 2、6 和 24 小时的评分中位数（四分位数间距[范围]）均低于对照组（2 小时：0[0-3{0-4}) 0 [0-3{0-4}] vs 3 [0-3 {0-6}], P = .048；6 小时：0 [0-3{0-6}] vs 2 [0-4 {0-6}]，P = .048；24 小时：0 [0-1 {0-7}] vs 0 [0-2 {0-6}]; P = .011）。G 组有 14 名患者（20.3%，14/69）的 SGA 装置上有血迹，明显低于 C 组（37.7%，26/69）（P = .024）。在 SGA 装置有血迹的患者中，G 组 POST 评分 >3 的发生率（14.3%，2/14）明显低于 C 组（73.1%，19/26）（P < .001），而在 SGA 装置无血迹的患者中，两组 POST 评分 >3 的发生率无明显差异（G 组：9.1%，5/55；C 组：20.9%，9/43；P = .145）。
CONCLUSIONS: Chewing gum before surgery can effectively reduce POST with a SGA device for hysteroscopic surgery, especially in patients with pharyngeal mucosal injury.
结论：手术前咀嚼口香糖可以有效减少宫腔镜手术中使用 SGA 装置时的 POST，尤其是对咽部粘膜损伤的患者。
主要结果
G组在术后2、6、24小时分别有2例、6例、2例发生中重度POST。其中1例患者在3个时间点出现NRS >3, 1例患者在6小时和24小时均出现NRS >3。因此，G组共7例患者发生中度/重度POST。C组术后2、6、24 h分别有8例、19例、9例发生中重度POST。其中，4例患者术后2、6小时出现NRS >3, 4例患者术后6、24小时出现NRS >3。因此，C组共28例患者发生中/重度POST。结果，G组术后24小时内中/重度POST的发生率(10.1%，7/69)显著低于C组(40.6%，28/69)(P = 0.044)。G组术后2、6、24小时的中位数(四分位间距[范围])评分低于同期的对照组(2小时:0[0-3{0-4}]vs 3 [0-3{0-6}]，P = .048; 6 hours: 0[0-3{0-6}] vs 2 [0-4{0-6}]，P = 0.048; 24小时:0 [0-1 {0-7}]vs 0 [0-2 {0-6}]，P = .011)(表2)。
G组有14例(20.3%，14/69)患者SLIPA上有血渍，显著低于C组(37.7%，26/69)(P = .024)(表2)。考虑到SGA带血装置在一定程度上反映了喉部粘膜损伤，我们根据SLIPA是否有血迹进行了亚组分析。在有血渍患者中，G组>3评分发生率(14.3%，2/14)显著低于C组(73.1%，19/26)(P < .001)(表2)，而在无血渍患者中，G组与C组比较差异无统计学意义(5/55,9.1% vs 9/43, 20.9%;P = .145)。由于样本量小，G组也出现了相同的趋势，但差异无统计学意义。整体比较结果显示，血渍组术后2、6、24小时NRS评分显著高于非血渍组(2小时:P < .001;6小时:P < .001;(表3)对照组中，有血渍患者在2小时和6小时的NRS评分显著高于无血渍患者(2小时:3 [3-3{0 - 6}]vs 0[0-3{0-5}]，P = .001;6小时:4 [0-5{0-6}]vs 1 [0-3{0-6}]，P = .002)。
广义估计方程（GEE）用于确定各种干预措施对中/重度POST发生率的影响(表4)。结果显示，在控制手术时间、是否手术等危险因素后，不同干预措施对术后中度/重度POST发生率的影响显著(表4)。SLIPA上有血渍，术前嚼口香糖后出现中度/重度咽喉痛的几率降至0.386 (95% CI, 0.153-0.976;P = .044)。有血迹的SLIPA与2.374倍的中度/重度POST (95% CI, 1.157-4.870)发生率相关。对于小于1小时的短手术，手术时间(<30分钟或>30分钟)对中/重度术后发生率无影响(OR 0.168, 95% CI, 0.022-1.280)。
Refer
Effects of Preoperative Gum Chewing on Sore Throat After General Anesthesia With a Supraglottic Airway Device：A Randomized Controlled Trial.pdf
文章：徐宁
排版：肉肉
