曲安奈德对颈椎人工间盘置换术后吞咽困难的影响

Effect of triamcinolone acetonide on dysphagia after cervical disc replacement

[目的]观察咽后局部应用曲安奈德对缓解颈椎人工椎间盘置换术后吞咽困难的临床效果。[方法]160例颈椎人工椎间盘置换术患者随机分为两组。用药组80例在手术切口闭合之前将曲安奈德和条状明胶海绵混合物置于咽后间隙,空白组使用无曲安奈德的明胶海绵。比较两组患者性别、年龄、体重指数(Body Mass Index,BMI)、麻醉时间、手术出血量、切口引流量和手术节段。比较两组患者吞咽困难发生率、吞咽-生活质量(SWAL-QOL)评分、椎前软组织面积。[结果]两组患者性别、年龄、BMI、麻醉时间、手术出血量、切口引流量和手术节段差异无统计学意义(P>0.05)。术后1、4和8周吞咽困难发生率用药组较空白组明显减少,差异具有统计学意义(P<0.05)。术后1、4和8周用药组患者SWAL-QOL评分明显高于空白组,差异具有统计学意义(P<0.05)。术后1周和术后4周用药组患者椎前软组织面积明显低于空白组,差异具有统计学意义(P<0.05),术后8周椎前软组织面积两组之间差异无统计学意义(P>0.05)。[结论]术中咽后局部使用曲安奈德可有效改善颈椎人工椎间盘置换术后椎前软组织肿胀,从而减少术后吞咽困难。

[Objective]To observe the effect of local application of triamcinolone acetonide on dysphagia after cervical disc replacement.[Methods]A total of 160 patients who were performed cervical disc replacement were randomly divided into two groups.Of them,80 patients in the treatment group were placed a strip of gelfoam mixed with triamcinolone acetonide,while 80 patients in the control group were implanted a strip of gelfoam without triamcinolone acetonide in the posterior pharyngeal space before the surgical incision closed.The gender,age,body mass index,anesthesia time,surgical bleeding volume,drainage vol.ume and surgical segment involved were compared between the two groups.In addition,the incidence of dysphagia,swallow-tolife quality(SWAL-QOL)score,and pre-vertebral soft tissue swelling area were also compared between them at 1 week,4 weeks,and 8 weeks after surgery.[Results]There were no significant differences in gender,age,BMI,anesthesia time,intraop.erative blood loss,and drainage volume between the two groups(P>0.05).The incidence of dysphagia in the treatment group was significantly lower than that in the control group at 1,4 and 8 weeks after surgery,which all proved statistically significant(P<0.05).The SWAL-QOL scores in the treatment group were significantly higher than those in the control group at 1,4 and 8 weeks after surgery,which all were statistically significant(P<0.05).The areas of prevertebral soft tissue were significantly low.er in the treatment group than those in the control group at 1 and 4 weeks after surgery with statistically significant differences(P<0.05),although the difference between the two group became statistically insignificant at 8 weeks postoperatively(P>0.05).[Conclusion]The local use of triamcinolone acetonide does alleviate the anterior cervical soft tissue swelling,and relieve post.operative dysphagia after cervical disc replacement.