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皮质类固醇对甲状腺切除术后的嗓音变化有任何有益作用吗?

Does corticosteroid have any beneficial effect on voice change after thyroidectomy?

作者信息

Nasiri Shirzad, Shafag Shima, Khorgami Zhamak, Sodagari Nassim, Aminian Ali, Hedayat Anushiravan

机构信息

Department of General Surgery, Tehran University of Medical Sciences, Tehran, Iran.

出版信息

Am Surg. 2013 Dec;79(12):1258-62.

Abstract

Voice alteration is one of the most common complications after thyroidectomy. It has a serious effect on social communication and economic and psychosocial status of patients. It has been hypothesized that inflammation and edema in the surgery site has a major role in voice change after thyroidectomy. This randomized clinical trial study was design to evaluate the effect of a single preoperative dose of steroid on voice change after thyroidectomy. This is a prospective randomized clinical trial with registration no. IRCT201106306925N. From all definitive candidates for total thyroidectomy, eligible patients were selected after exclusion of 12 criteria. Selected cases were randomly allocated to two groups. One group received intravenous dexamethasone preoperatively. Other group received placebo. Voice change was evaluated by Voice Impairment Score (VIS) postoperatively. Sixty-four patients were entered in the study and divided into two groups (dexamethasone and placebo). VIS was significantly different at the first day after surgery between dexamethasone (five) and controls (13; P < 0.001). This difference was seen after 7 days but without statistically significance (one vs three; P = 0.397). VIS score significantly decreased on the seventh day related to the first day (P < 0.001) in both groups. There were no significant dexamethasone complications in either group. Preoperative dexamethasone may decrease voice change after thyroidectomy.

摘要

嗓音改变是甲状腺切除术后最常见的并发症之一。它对患者的社会交往以及经济和心理社会状况有严重影响。据推测,手术部位的炎症和水肿在甲状腺切除术后嗓音改变中起主要作用。这项随机临床试验研究旨在评估术前单次给予类固醇对甲状腺切除术后嗓音改变的影响。这是一项前瞻性随机临床试验,注册号为IRCT201106306925N。从所有甲状腺全切术的最终候选者中,排除12项标准后选择符合条件的患者。将所选病例随机分为两组。一组术前接受静脉注射地塞米松。另一组接受安慰剂。术后通过嗓音障碍评分(VIS)评估嗓音改变情况。64例患者进入研究并分为两组(地塞米松组和安慰剂组)。术后第一天,地塞米松组(5分)和对照组(13分)的VIS有显著差异(P<0.001)。7天后也存在这种差异,但无统计学意义(1分对3分;P=0.397)。两组中VIS评分在第七天均较第一天显著降低(P<0.001)。两组均未出现明显的地塞米松相关并发症。术前使用地塞米松可能会减少甲状腺切除术后的嗓音改变。

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