围术期小剂量地塞米松对甲状腺肿瘤切除术后咽喉痛的预防作用

Protective effect of perioperative low-dose dexamethasone on sore throat after thyroidectomy

目的通过疼痛评分量表分析围术期小剂量地塞米松对甲状腺术后咽喉痛的预防作用。方法将符合纳入标准的甲状腺手术患者随机分为地塞米松组(n=103)和生理盐水组(n=130),分别于麻醉诱导时静脉注射0.1 mg/kg地塞米松或等体积的生理盐水。甲状腺术后对患者切口痛及咽喉痛(静息痛及吞咽痛)进行视觉模拟评分(VAS),记录患者术后恶心呕吐的发生率,进行主诉疼痛分级法(VRS)评分。检测患者术前、术后血糖水平,观察术后切口是否发生感染。结果地塞米松组术后使用镇痛药物的患者比例(18.4%)明显低于生理盐水组(58.5%),差异具有统计学意义(P=0.000);地塞米松组术后使用止吐药物的患者比例(1.0%)低于生理盐水组(6.2%),差异具有统计学意义(P=0.041);地塞米松组术后第1日血糖明显高于生理盐水组(P=0.000),第2日回到基线水平;2组患者术后切口感染率比较,差异无统计学意义(P=0.848)。结论围术期小剂量地塞米松可以减轻甲状腺术后咽喉痛及切口痛,降低甲状腺术后恶心呕吐的发生率;甲状腺患者术后第1日血糖升高,无高血糖不良事件发生。

Objective To analyze the protective effect of perioperative low-dose dexamethasone on sore throat after thyroidectomy by the use of the pain rating scale.Methods Patients who underwent the thyroid surgery and met the inclusion criteria were randomly assigned to the dexamethasone group（n=103） and the saline group（n= 130）.Patients were intravenously injected with 0.1 mg/kg of dexamethasone or same volume of saline at the induction of general anesthesia.The visual analogue scale（VAS） was used to assess incision pain and throat pain（at rest and in swallow） of patients after thyroid surgery.The incidences of postoperative nausea and vomiting were recorded and assessed with the verbal rating scale（VRS）.Blood glucose levels before and after surgery were measured and postoperative incision infections were observed.Results The proportion of patients receiving antiemetic drugs after surgery was markedly lower in the dexamethasone group（18.4%） than in the saline group（58.5%） and the difference was statistically significant（P=0.000）.The proportion of patients receiving analgesic drugs after surgery was lower in the dexamethasone group（1.0%） than in the saline group（6.2%） and the difference was statistically significant（P=0.041）.The blood glucose levels in the dexamethasone group were markedly higher than those in the saline group 1 d after surgery（P=0.000） and returned to the baseline level on the next day.The difference in the rate of postoperative incision infections between two groups was not statistically significant（P=0.848）.Conclusion Perioperative low-dose dexamethasone can reduce incision pain and throat pain,as well as incidences of nausea and vomiting after thyroidectomy.The blood glucose level 1 d after thyroidectomy was elevated with no high blood glucose adverse events.