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(shù)中的應(yīng)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(shù)術(shù)后頭痛的有效性。方法86例擇期行甲狀腺手術(shù)的患者隨機(jī)分為2組：對(duì)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(jì)給予氟比洛芬酯100 mg。術(shù)后24、48 h隨訪，根據(jù)VAS評(píng)分(視覺疼痛模擬評(píng)分)兩次評(píng)分均值>4分診斷為術(shù)后頭痛。結(jié)果兩組患者術(shù)后切口疼痛24、48 h VAS評(píng)分比較差異無統(tǒng)計(jì)學(xué)意義(P>0.05)；對(duì)照組發(fā)生術(shù)后頭痛10例(23.3%)，氟比洛芬酯組發(fā)生術(shù)后頭痛2例(4.7%)，兩組比較差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。結(jié)論術(shù)中應(yīng)用氟比洛芬酯可以緩解甲狀腺手術(shù)術(shù)后頭痛。

甲狀腺切除術(shù)；術(shù)后頭痛；氟比洛芬酯

0　引言

隨著甲狀腺疾病發(fā)病率的增加，超聲診斷技術(shù)的提高，越來越多的患者接受外科手術(shù)治療甲狀腺疾病。有研究者應(yīng)用機(jī)器人手術(shù)輔助系統(tǒng)完成甲狀腺手術(shù)[1]，且可以應(yīng)用儀器實(shí)時(shí)完成喉返神經(jīng)的監(jiān)測(cè)[2]。此外，麻醉藥物的選擇也為患者安全舒適的度過圍手術(shù)期提供了更多的保障[3-4]。

已有文獻(xiàn)探討甲狀腺手術(shù)后頭痛的原因和體位改良[5]，但圍術(shù)期麻醉管理方案的變化，能否改善患者術(shù)后頭痛的癥狀并未見報(bào)道。雖然麻醉醫(yī)生擅長(zhǎng)應(yīng)用強(qiáng)效的阿片類藥物為患者解除圍術(shù)期強(qiáng)烈的切口疼痛，但是甲狀腺手術(shù)術(shù)后的頭痛無論從疼痛的程度還是疼痛的性質(zhì)，都不同于以往外科手術(shù)后疼痛。本文旨在通過隨機(jī)雙盲對(duì)照的臨床研究，探討預(yù)防性應(yīng)用氟比洛芬酯是否能夠改善甲狀腺手術(shù)術(shù)后頭痛。

1　資料與方法

1.1一般資料選擇2014年1-12月在我院行甲狀腺手術(shù)患者86例。本研究經(jīng)我院倫理委員會(huì)批準(zhǔn)?；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(jī)數(shù)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(dǎo)管前給予氟比洛芬酯(北京泰德制藥有限公司)50 mg靜注；對(duì)照組43例，分別于切皮后、拔出氣管導(dǎo)管前給予生理鹽水5 mL靜注?；颊吆托g(shù)后隨訪研究人員對(duì)給藥情況雙盲。排除標(biāo)準(zhǔn)：長(zhǎng)期服用非甾體類抗炎藥物；術(shù)前并存嚴(yán)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(shù)(BIS)監(jiān)測(cè)。麻醉誘導(dǎo)藥物：咪達(dá)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(dǎo)后行氣管插管，術(shù)中機(jī)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(shù)后頭痛診斷標(biāo)準(zhǔn)疼痛視覺模擬評(píng)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(shù)后24、48 h兩次隨訪術(shù)后頭痛情況，根據(jù)VAS評(píng)分均值>4分診斷為術(shù)后頭痛。

2　結(jié)果

2.1兩組患者一般情況比較兩組患者性別構(gòu)成、年齡、身高、體重、手術(shù)時(shí)間和舒芬太尼用量比較差異無統(tǒng)計(jì)學(xué)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(shù)后VAS評(píng)分比較兩組患者術(shù)后24、48 h VAS評(píng)分差異無統(tǒng)計(jì)學(xué)意義(P>0.05)。按照本研究定義，根據(jù)VAS評(píng)分2次均值>4分診斷為術(shù)后頭痛，對(duì)照組發(fā)生術(shù)后頭痛10例，氟比洛芬酯組2例，兩組比較差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。見表2。

表2　兩組患者術(shù)后VAS評(píng)分和頭痛情況比較(例，%)

注：*與對(duì)照組比較，P<0.05

3　討論

甲狀腺疾病發(fā)病率不斷增加，術(shù)后并發(fā)癥也越來越受到重視。手術(shù)后頭痛的原因已有文獻(xiàn)報(bào)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(shù)牽拉神經(jīng)反射等因素[6]都可能造成術(shù)后頭痛。但圍術(shù)期麻醉管理方案是否影響手術(shù)后頭痛未見文獻(xiàn)報(bào)道。本研究發(fā)現(xiàn)，氟比洛芬酯組患者術(shù)后頭痛發(fā)生率低于對(duì)照組，為臨床麻醉工作中藥物選擇提供了理論根據(jù)。

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(shù)區(qū)炎性反應(yīng)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(shù)后鎮(zhèn)痛。甲狀腺手術(shù)后頭痛的機(jī)制較復(fù)雜，體位、血管、神經(jīng)因素均有可能參與其中，而應(yīng)用非選擇性的環(huán)氧化酶抑制劑可以減輕手術(shù)后炎性反應(yīng)，很好地緩解了這種特殊性質(zhì)的術(shù)后并發(fā)癥。

綜上所述，甲狀腺手術(shù)術(shù)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(shù)后頭痛，提高麻醉質(zhì)量，不失為臨床工作中一個(gè)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(guó)醫(yī)科大學(xué)第一醫(yī)院麻醉科，沈陽 110001

遼寧省自然科學(xué)基金(2014021035)

10.14053/j.cnki.ppcr.201609020