Ultrasound-guided local injection of dexamethasone and lidocaine into subcapsule for subacute thyroiditis
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摘要: 目的 探讨超声引导包膜下注射地塞米松及利多卡因混合液在治疗亚急性甲状腺炎(SAT)的有效性及安全性。 方法 将93例SAT患者随机分为注射组(A组)48例和泼尼松龙组(B组)45例，A组在超声引导下行甲状腺病变区域包膜下注射地塞米松及利多卡因混合液治疗，B组行传统口服药物泼尼松龙治疗。对比两组的疼痛缓解时间、治疗周期、甲状腺功能恢复情况及复发率、并发甲减及药物不良反应等。 结果 随访6个月，A组在疼痛缓解时间、治疗周期、甲状腺功能恢复上显著短于B组，差异有统计学意义(P<0.05)；在复发率及甲减发生上两组差异无统计学意义(P>0.05)。 结论 与口服泼尼松龙治疗方式相比，超声引导下局部注射地塞米松及利多卡因混合液能快速缓解疼痛，治疗周期更短，不良反应少，操作风险可控。Abstract: Objective To compare the efficacy and safety of ultrasound-guided local injection of the mixture of dexamethasone(DEX) with lidocaine and oral prednisolone(PSL) in treating patients with subacute thyroiditis. Methods Ninety-three patients with subacute thyroiditis were divided into group A(n=48) and Group B(n=45). Group A was treated with ultrasound-guided subcapsular injection in thyroid lesion area, while group B was treated with oral medication. The pain relief time, the duration of treatment, thyroid function recovery, recurrence rate, concurrent hypothyroidism, and drug side effects were compared between the two groups. Results After 6 months of follow-up, the pain relief time, the duration of treatment and thyroid function recovery in group A were significantly shorter than those in group B (P<0.05), but not the recurrence rate and hypothyroidism(P＞0.05). Conclusion Compared with oral PSL treatment, ultrasound-guided local injection of DEX and lidocaine mixture can quickly relieve pain, shorter the duration of treatment and lower adverse reactions.
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Key words:
- subacute thyroiditis /
- ultrasound-guided /
- dexamethasone /
- lidocaine
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表 1 两组一般特征
项目 A组 B组 P 例数 48 45 性别(男/女) 7/41 7/38 >0.05 年龄/岁 45.56±8.89 44.86±6.54 >0.05 发病至就诊时间/d 6.19±4.95 7.56±3.24 >0.05 临床表现 颈部吞咽性疼痛
(+/-)48/0 45/0 — 发热(+/-) 6/42 5/40 >0.05 心悸(+/-) 12/36 10/35 >0.05 多汗(+/-) 10/38 6/39 >0.05 体重减轻(+/-) 21/27 19/26 >0.05 实验室检查 白细胞计数/
(×109·L-1)6.62±1.02 6.42±1.13 >0.05 中性粒细胞数/
(×109·L-1)4.25±0.25 4.31±0.21 >0.05 FT4/
(pmol· L-1)26.60±11.67 25.94±11.02 >0.05 TSH/
(μIU· mL-1)0.21±0.39 0.19±0.26 >0.05 ESR(+/-) 46/2 44/1 >0.05 
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表 2 两组临床疗效评价
项目 A组 B组 P 疼痛评分(0~3) <2.5 h 48 0 <0.01 1~2 d 45 22 >0.05 3~6 d 46 23 >0.05 > 6 d 46 25 >0.05 疼痛缓解时间 2.5 h
(10 min~5 h)5 d
(7~12 d)<0.01 治疗周期/d 6(2~32) 20(5~190) <0.05 甲状腺功能情况 FT3/(pmol·L-1) 4周 6.13±2.06 8.05±1.72 <0.05 8周 6.09±1.42 7.31±2.30 <0.05 12周 5.52±2.43 6.14±1.68 >0.05 FT4/(pmol·L-1) 4周 14.42±7.01 20.54±9.62 <0.01 8周 12.06±8.54 17.06±7.62 <0.05 12周 12.54±4.03 14.10±5.25 >0.05 TSH/(μIU·mL-1) 4周 1.14±0.28 0.42±1.36 <0.01 8周 2.21±1.42 1.18±0.37 <0.01 12周 2.68±1.95 2.02±0.48 >0.05 ESR/(mm·h -1) 4周 6.21±4.74 26.74±7.45 <0.01 8周 6.02±3.89 12.42±4.61 <0.01 12周 7.01±2.04 6.25±3.52 >0.05 复发/例 3 5 >0.05 甲减或亚临床甲减/例 5 3 >0.05 减/例
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