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围手术期小剂量地塞米松对甲状腺手术后引流液中炎症因子及切口愈合的影响。

Effects of low-dose dexamethasone on inflammatory factors in drainage fluid and wound healing after thyroid surgery during perioperative period.

机构信息

Department of Anesthesiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.

Department of Anesthesiology, Shanghai Jiaotong University Affiliated Shanghai Sixth People's Hospital, Shanghai, China.

出版信息

Int Wound J. 2023 Aug;20(6):2141-2150. doi: 10.1111/iwj.14090. Epub 2023 Mar 1.

Abstract

This study explored the effect of perioperative use of low-dose dexamethasone on inflammatory factors in drainage fluid and wound healing after thyroid surgery. In the prospective, double-blinded, randomised controlled study, adults who underwent elective thyroidectomy received 0.1 mg/kg of intravenous dexamethasone or a matching volume of placebo (saline) after induction of general anaesthesia. The primary outcome was IL6 and IL10 concentration in drainage at 24 hours postoperative. The secondary endpoint was the SBSES (modified Stony Brook Scar Evaluation Scale) total score at 1 week postoperative. From 8 July to 17 December 2020, 64 patients (mean [SD] age, 40.42 [9.52]; 13 males [20.31%]) were recruited, received operation, and completed the 1-month follow-up. Inflammatory factors in drainage did not differ between the two groups but only had significant differences at different timepoint. The dexamethasone group patients had a higher SBSES total score at 1 week after the treatment but, without statistical significance (dexamethasone vs placebo: 3.13 ± 1.24 vs 2.97 ± 0.93, P = .571). The dexamethasone group patients had a higher SBSES total score (dexamethasone vs placebo: 3.103 ± 1.148 vs 2.868 ± 0.827, P = .011) and colour score (dexamethasone vs placebo: 0.603 ± 0.493 vs 0.412 ± 0.496, P = .026) at 1-week follow-up than the placebo group patients. Preoperative single small-dose intravenous dexamethasone did not show to improve wound healing quality nor reduce incision inflammation but may release pain, and reduce tissue angiogenesis, and thus the scar redness.

摘要

本研究探讨了围手术期使用低剂量地塞米松对甲状腺手术后引流液中炎症因子和伤口愈合的影响。在这项前瞻性、双盲、随机对照研究中,接受择期甲状腺切除术的成年人在全身麻醉诱导后接受 0.1mg/kg 静脉内地塞米松或等量安慰剂(生理盐水)。主要结局是术后 24 小时引流液中 IL6 和 IL10 的浓度。次要终点是术后 1 周时的 SBSES(改良 Stony Brook 瘢痕评估量表)总评分。2020 年 7 月 8 日至 12 月 17 日,共纳入 64 例患者(平均[标准差]年龄 40.42[9.52];男性 13 例[20.31%]),均接受手术治疗并完成了 1 个月的随访。两组患者引流液中的炎症因子无差异,但仅在不同时间点有显著差异。治疗后 1 周时,地塞米松组患者的 SBSES 总评分较高,但差异无统计学意义(地塞米松与安慰剂:3.13±1.24 比 2.97±0.93,P=.571)。地塞米松组患者的 SBSES 总评分(地塞米松与安慰剂:3.103±1.148 比 2.868±0.827,P=.011)和色泽评分(地塞米松与安慰剂:0.603±0.493 比 0.412±0.496,P=.026)在术后 1 周时均高于安慰剂组患者。术前单次小剂量静脉内地塞米松并不能改善伤口愈合质量,也不能减轻切口炎症,但可能减轻疼痛、减少组织血管生成,从而减轻瘢痕的红色。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/36d1/10333005/5097a2729808/IWJ-20-2141-g003.jpg

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