甲状腺切除术后血肿的围手术期风险因素：疼痛和酮咯酸使用的意义。
Perioperative risk factors for post-thyroidectomy hematoma: Significance of pain and ketorolac usage.
机构信息
Department of Otorhinolaryngology-Head & Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Department of Otorhinolaryngology-Head & Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
出版信息
Head Neck. 2019 Oct;41(10):3656-3660. doi: 10.1002/hed.25895. Epub 2019 Aug 7.
BACKGROUND
Post-thyroidectomy hematoma (PH) is uncommon but may be a life-threatening complication. We explored perioperative risk factors for PH, with emphasis on perioperative hemodynamics, pain, and medications.
METHODS
A retrospective case-control study was performed with matching for age, sex, and type of operation. Univariate and multivariate analyses were performed to identify independent risk factors.
RESULTS
In 1780 thyroid surgeries, 22 cases of PH were detected (1.24%). Antithrombotic agent usage, numeric rating scale (NRS) of postoperative pain, and two or more doses of ketorolac postoperatively significantly differed between the two groups. Multiple regression analysis revealed all three variables were significant risk factors for PH (odds ratio = 55.23, 10.48, and 22.58, respectively). Perioperative hemodynamics did not affect PH.
CONCLUSIONS
Antithrombotic agent usage, postoperative pain, and two or more doses of ketorolac postoperatively were identified as independent risk factors for PH. Proper pain control and judicious usage of ketorolac are recommended.
背景
甲状腺切除术后血肿（PH）并不常见，但可能是一种危及生命的并发症。我们探讨了 PH 的围手术期危险因素，重点关注围手术期血液动力学、疼痛和药物。
方法
本研究进行了回顾性病例对照研究，并进行了年龄、性别和手术类型的匹配。进行了单因素和多因素分析，以确定独立的危险因素。
结果
在 1780 例甲状腺手术中，发现 22 例 PH（1.24%）。抗血栓药物的使用、术后疼痛的数字评分量表（NRS）和术后使用两次或更多剂量的酮咯酸在两组之间有显著差异。多因素回归分析显示，这三个变量均是 PH 的显著危险因素（比值比分别为 55.23、10.48 和 22.58）。围手术期血液动力学并不影响 PH。
结论
抗血栓药物的使用、术后疼痛和术后使用两次或更多剂量的酮咯酸是 PH 的独立危险因素。建议适当控制疼痛和合理使用酮咯酸。
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