糖皮质激素在甲状腺癌围手术期患者中的应用分析
Effect of glucocorticoids on perioperative patients with thyroid cancer
目的 探讨复杂甲状腺癌手术患者围手术期使用糖皮质激素的应用效果.方法 选取2017年1月至2017年12月郑州大学第一附属医院甲状腺外一科接受治疗的甲状腺癌手术时长>3 h的患者373例作为对照组,2018年1月至2018年12月郑州大学第一附属医院甲状腺外一科接受治疗的甲状腺癌手术时长>3 h的患者386例作为观察组.对照组患者未给予围手术期糖皮质激素治疗,观察组患者则给予围手术期糖皮质激素应用治疗,观察比较两组患者术后拔引流管时间、术后住院时间、术后并发症发生率及患者术后感染、伤口愈合延迟的发生率.结果 观察组患者术后拔引流管天数(2.5±0.42 vs 3.2±0.63,t=25.72,P<0.001)及术后住院时间(3.6±0.57 vs 4.8±0.71,t=18.07,P<0.001)均短于对照组患者;观察组术后呼吸音粗(3.1% vs 6.7%,x2=4.790,P=0.029)、轻中度呼吸困难(1.0% vs 3.2%,x2=4.191,x2=0.041)、咳嗽咳痰(8.3% vs14.2%,x2=5.366,P=0.021)、咽痛(4.9% vs 9.4%,x=4.952,P=0.026)、头痛(8.8% vs 11.5%,x2=4.392,P=0.036)、恶心呕吐(3.6% vs 8.6%,x2=7.235,P=0.007)等并发症的发生率均低于对照组患者,而两组患者术后声嘶发生率差异无统计学意义(1.6% vs 2.1%,x2=0.352,P=0.553);两组患者术后感染(2例vs 1例,x2=0.299,P=0.585)、伤口愈合延迟(3例vs 3例,x2=0.002,P=0.964)的发生差异无统计学意义.结论 对复杂甲状腺癌手术患者围术期应用糖皮质激素,能有效地减少并发症的发生,同时能缩短患者的住院时间,可行性高.
更多Objective To investigate the application effect of glucocorticoids on perioperative period of complicated thyroid cancer surgery.Methods All patients were from Department of Thyroid Surgery,the First Affiliated Hospital of Zhengzhou University.A total of 373 patients with thyroid surgery longer than 3 hours from Jan.2017 to Dec.2017 were as the control group.386 patients with thyroid surgery longer than 3 hours from Jan.2018 to Dec.2018 were included in the observation group.Patients in the control group were not treated with glucocorticoids during perioperative period,and patients in the observation group were treated with glucocorticoids during perioperative period.Several factors were compared between the two groups,including postoperative drain removal time,postoperative hospitalization time,postoperative complication rate,the incidence of postoperative infection and delayed wound healing.Results The postoperative drain removal time [(2.5±0.42) vs (3.2±0.63),t=25.72,P<0.001)] and the postoperative hospitalization time [(3.6±0.57) vs (4.8±0.71),t=18.07,P<0.001)] in the observation group was shorter than in the control group.The incidence of complications in the observation group was lower than that in the control group,such as postoperative coarse respiratory sounds (3.1% vs 6.7%,x2=4.790,P=0.029),mild to moderate dyspnea (1.0% vs 3.2%,x2=4.191,P=0.041),cough (8.3% vs 14.2%,x2=5.366,P=0.021),sore throat (4.9% vs 9.4%,x2=4.952,P=0.026),headache (8.8% vs 11.5%,x2=4.392,P=0.036) and nausea (3.6% vs 8.6%,x2=7.235,P=0.007),however,the incidence of hoarseness between the two groups was statistically significant (1.6% vs 2.1%,x2=0.352,P=0.553).There was no significant difference in the incidence of postoperative infection (2 cases vs 1 case,x2=0.299,P=0.585) or delayed wound healing (3 cases vs 3 cases,x2=0.002,P=0.964) between the two groups.Conclusion The application of glucocorticoids in patients with complicated thyroid cancer surgery can effectively reduce the incidence of complications and shorten the hospitalization time of patients.
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