地塞米松混合罗哌卡因用于颈神经通路阻滞对甲状腺手术患者术后吞咽功能的影响
Effect of dexamethasone mixed with ropivacaine for cervical nerve pathway blockade on postopera-tive swallowing function in patients undergoing thyroid surgery
钱龙 1水维康 2马文文 3王钦阁 3朱珊珊1
作者信息
- 1. 徐州医科大学麻醉学院,徐州 221000;徐州市肿瘤医院麻醉科,徐州 221000
- 2. 徐州医科大学麻醉学院,徐州 221000
- 3. 徐州市肿瘤医院麻醉科,徐州 221000
- 折叠
摘要
目的 探讨地塞米松混合罗哌卡因用于颈神经通路阻滞对甲状腺手术患者术后吞咽功能的影响.方法 本研究为前瞻性随机对照试验.选取徐州市肿瘤医院2023年3月至12月择期行甲状腺切除术患者124例,性别不限,年龄18～60岁,ASA分级Ⅰ或Ⅱ级,按随机数字表法分为试验组(DR组)和对照组(R组),每组62例.全凭静脉麻醉诱导后分别行双侧颈神经通路阻滞,DR组患者注射地塞米松5 mg+0.25％罗哌卡因10 ml,R组患者注射0.25％罗哌卡因10 ml.主要结局指标:分别于术后1和6 d时采用标准吞咽功能评价量表(SSA)评价吞咽功能,记录吞咽功能障碍(任意一个指标异常)发生情况.次要结局指标:分别于气管拔管即刻、气管拔管后4、8、12、24和48 h时,记录静态和吞咽状态下NRS评分.分别于术后1和6 d时采用嗓音障碍指数量表(VHI-10)评价嗓音功能;记录术后酮咯酸氨丁三醇使用情况和不良反应发生情况.结果 最终DR组纳入61例,R组纳入60例.与R组比较,DR组术后1和6 d时SSA评分、术后1 d时吞咽障碍发生率降低,气管拔管后8和12 h时静态、气管拔管后4～24 h时吞咽状态下NRS评分降低,术后恶心呕吐发生率、术后1 d时VHI-10评分降低,酮咯酸氨丁三醇使用例次减少(P＜0.05).结论 地塞米松混合罗哌卡因用于颈神经通路阻滞可改善甲状腺手术患者术后吞咽功能.
Abstract
Objective To investigate the effect of dexamethasone mixed with ropivacaine for cervi-cal nerve pathway blockade on the postoperative swallowing function in patients undergoing thyroid surgery.Methods This was a prospective randomized controlled trial.One hundred twenty-four patients,regardless of gender,aged 18-60 yr,of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ,who underwent elective thyroidectomy at Xuzhou Cancer Hospital from March to December 2023,were se-lected and divided into test group(DR group,n=62)and control group(R group,n=62)using a random number table method.After induction of total intravenous anesthesia,bilateral cervical nerve pathway block-ade was performed,dexamethasone 5 mg and 0.25％ropivacaine 10 ml were injected in DR group,and 0.25％ropivacaine 10 ml was injected in group R.Main outcome measures:The swallowing function was as-sessed using Standard Swallowing Assessment scale at 1 and 6 days postoperatively,and the occurrence of swallowing dysfunction(abnormal in any indicator)was recorded.Secondary outcome measures:numerical rating scale scores were recorded immediately after tracheal extubation and at 4,8,12,24 and 48 h after tracheal extubation in both static and swallowing states.Voice function was evaluated using the Voice Handi-cap Index-10 at 1 and 6 days postoperatively.The use of ketorolac tromethamine and occurrence of adverse reactions after surgery were recorded.Results Sixty-one patients were finally included in DR group and 60 patients in R group.Compared with R group,the Standard Swallowing Assessment scale scores at 1 and 6 days after operation and incidence of swallowing disorders at 1 day after operation were significantly de-creased,the numerical rating scale scores at 8 and 12 h after tracheal extubation in the static state and at 4-24 h after tracheal extubation in the swallowing state were decreased,the incidence of postoperative nausea and vomiting and Voice Handicap Index-10 scores at 1 day after operation were decreased,and the number of patients who used ketorolac tromethamine was reduced in DR group(P＜0.05).Conclusions Dexam-ethasone mixed with ropivacaine for cervical nerve pathway blockade can improve the postoperative swallo-wing function in patients undergoing thyroid surgery.
关键词
地塞米松/罗哌卡因/神经传导阻滞/甲状腺切除术/吞咽障碍/颈神经Key words
Dexamethasone/Ropivacaine/Nerve block/Thyroidectomy/Deglutition disor-ders/Cervical nerve引用本文复制引用
出版年
2024
NETL
NSTL
万方数据