譚文斐,金 鳳,崔 湧,田阿勇,馬 虹,呂黃偉
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氟比洛芬酯在甲狀腺手術中的應用
譚文斐*,金鳳,崔湧,田阿勇,馬虹,呂黃偉
目的探討氟比洛芬酯治療甲狀腺手術術后頭痛的有效性。方法86例擇期行甲狀腺手術的患者隨機分為2組:對照組(43例):全麻拔管前給予生理鹽水,氟比洛芬酯組(43例):全麻拔管前共計給予氟比洛芬酯100 mg。術后24、48 h隨訪,根據VAS評分(視覺疼痛模擬評分)兩次評分均值>4分診斷為術后頭痛。結果兩組患者術后切口疼痛24、48 h VAS評分比較差異無統(tǒng)計學意義(P>0.05);對照組發(fā)生術后頭痛10例(23.3%),氟比洛芬酯組發(fā)生術后頭痛2例(4.7%),兩組比較差異有統(tǒng)計學意義(P<0.05)。結論術中應用氟比洛芬酯可以緩解甲狀腺手術術后頭痛。
甲狀腺切除術;術后頭痛;氟比洛芬酯
隨著甲狀腺疾病發(fā)病率的增加,超聲診斷技術的提高,越來越多的患者接受外科手術治療甲狀腺疾病。有研究者應用機器人手術輔助系統(tǒng)完成甲狀腺手術[1],且可以應用儀器實時完成喉返神經的監(jiān)測[2]。此外,麻醉藥物的選擇也為患者安全舒適的度過圍手術期提供了更多的保障[3-4]。
已有文獻探討甲狀腺手術后頭痛的原因和體位改良[5],但圍術期麻醉管理方案的變化,能否改善患者術后頭痛的癥狀并未見報道。雖然麻醉醫(yī)生擅長應用強效的阿片類藥物為患者解除圍術期強烈的切口疼痛,但是甲狀腺手術術后的頭痛無論從疼痛的程度還是疼痛的性質,都不同于以往外科手術后疼痛。本文旨在通過隨機雙盲對照的臨床研究,探討預防性應用氟比洛芬酯是否能夠改善甲狀腺手術術后頭痛。
1.1一般資料選擇2014年1-12月在我院行甲狀腺手術患者86例。本研究經我院倫理委員會批準?;颊咦栽讣尤肱R床研究并且簽署知情同意書。86例患者按照隨機數字表法分為2組。氟比洛芬酯組43例,分別于切皮后、拔出氣管導管前給予氟比洛芬酯(北京泰德制藥有限公司)50 mg靜注;對照組43例,分別于切皮后、拔出氣管導管前給予生理鹽水5 mL靜注?;颊吆托g后隨訪研究人員對給藥情況雙盲。排除標準:長期服用非甾體類抗炎藥物;術前并存嚴重心腦疾病病史;年齡超過65歲。
1.2方法
1.2.1麻醉方法兩組麻醉方法相同:入室常規(guī)心電圖、無創(chuàng)袖帶壓、脈搏血氧飽和度、腦電雙頻指數(BIS)監(jiān)測。麻醉誘導藥物:咪達唑侖0.04 mg/kg,順式阿曲庫銨0.2 mg/kg,依托咪酯0.3 mg/kg,舒芬太尼0.6 μg/kg。麻醉誘導后行氣管插管,術中機械通氣,麻醉維持丙泊酚4~6 mg/(kg·h),瑞芬太尼 0.1~0.5 μg/(kg·min),七氟烷呼氣末濃度1.5~2 MAC,BIS值40~60。
1.2.2術后頭痛診斷標準疼痛視覺模擬評分(VAS):1~3分為輕度疼痛,4~6分為中度疼痛,7~10分為重度疼痛。術后24、48 h兩次隨訪術后頭痛情況,根據VAS評分均值>4分診斷為術后頭痛。
2.1兩組患者一般情況比較兩組患者性別構成、年齡、身高、體重、手術時間和舒芬太尼用量比較差異無統(tǒng)計學意義(P>0.05)。見表1。
表1 兩組患者一般情況比較(例)
2.2兩組患者術后VAS評分比較兩組患者術后24、48 h VAS評分差異無統(tǒng)計學意義(P>0.05)。按照本研究定義,根據VAS評分2次均值>4分診斷為術后頭痛,對照組發(fā)生術后頭痛10例,氟比洛芬酯組2例,兩組比較差異有統(tǒng)計學意義(P<0.05)。見表2。
表2 兩組患者術后VAS評分和頭痛情況比較(例,%)
注:*與對照組比較,P<0.05
甲狀腺疾病發(fā)病率不斷增加,術后并發(fā)癥也越來越受到重視。手術后頭痛的原因已有文獻報道,患者焦慮的精神狀態(tài)、頸部過度伸展、頸靜脈回流障礙、手術牽拉神經反射等因素[6]都可能造成術后頭痛。但圍術期麻醉管理方案是否影響手術后頭痛未見文獻報道。本研究發(fā)現,氟比洛芬酯組患者術后頭痛發(fā)生率低于對照組,為臨床麻醉工作中藥物選擇提供了理論根據。
氟比洛芬酯是一種可以靜脈注射的具有靶向鎮(zhèn)痛作用的非甾體類抗炎藥物[7-8]。氟比洛芬是一種非選擇性的環(huán)氧化酶抑制劑,通過減少前列腺素合成、減輕術區(qū)炎性反應而起到鎮(zhèn)痛作用[9-12]。而氟比洛芬酯是氟比洛芬的前體藥,其以脂微球作為載體,具有向炎癥及創(chuàng)傷組織聚集的靶向性,廣泛用于術后鎮(zhèn)痛。甲狀腺手術后頭痛的機制較復雜,體位、血管、神經因素均有可能參與其中,而應用非選擇性的環(huán)氧化酶抑制劑可以減輕手術后炎性反應,很好地緩解了這種特殊性質的術后并發(fā)癥。
綜上所述,甲狀腺手術術中給予非選擇性環(huán)氧化酶抑制劑氟比洛芬酯,可以改善患者術后頭痛,提高麻醉質量,不失為臨床工作中一個有效的選擇。
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Application of flurbiprofen axetil in thyroidectomy
TAN Wen-fei*,JIN Feng,CUI Yong,TIAN A-yong,MA Hong,Lü Huang-wei
(Department of Anesthesiology,the First Hospital of China Medical University,Shenyang 110001,China)
ObjectiveTo investigate the effect of flurbiprofen axetil on postoperative headache induced by thyroidectomy.MethodsEighty-six patients were divided into two groups randomly.All the patients underwent general anesthesia,and patients in control group and flurbiprofen axetil group were given sodium chloride injection and flurbiprofen axetil 100 mg.The visual analogue scale (VAS) score was recorded at 24 and 48 h after operation.Postoperative headache was diagnosed when VAS>4.ResultsThere was no significant difference in VAS scores between the two groups at 24 and 48 h after treatment (P>0.05).10 cases (23.3%) of control group,and 2 cases (4.7%) in flurbiprofen axetil group had postoperative headache,there being significant difference between the two groups (P<0.05).ConclusionAdministration of flurbiprofen axetil during operation can release postoperative headache induced by thyroidectomy.
Thyroidectomy;Postoperative headache;Flurbiprofen axetil
2016-03-23
中國醫(yī)科大學第一醫(yī)院麻醉科,沈陽 110001
遼寧省自然科學基金(2014021035)
10.14053/j.cnki.ppcr.201609020