Clinical Research Of Mannitol And Small Dose Of Dexamethasone Effect On Headache, Dizziness, Nausea And Vomiting After Thyroidectomy

Objective: Research effect observation of mannitol and small doseof dexamethasone alleviating symptoms of headache, dizziness, nauseaand vomiting after thyroidectomy. Thyroid is an important organ inendocrine system, which possibly occur rumor, inflammatory, functionaldiseases and so on. At present, many diseases of the thyroid gland need tobe treated with surgical operations, while these treatments may beproduce associated complications. Among them the most commonsymptoms are headache, dizziness, nausea, vomiting after thyroidresection. Why the patients get headache, dizziness, nausea and vomitingafter thyroidectomy? Now research from domestic and abroad think itmajorly concerns with preoperative patient's mental state, operativeposition, operative stimulation, anesthesia, etc. The effect of operativeposition is considered as may be the major reason since the patient'shyperextention of neck during thyroid surgery. Because of thecompression of cervical vascular, the blood flow to the brain reduces,venous reflux obstructs. All of these will increase the intracranial pressure,which produces headache, dizziness, nausea and vomiting after surgery.Mannitol can dehydrate and decrease the intracranial pressure, whiledexamethasone can enhance mannitol decrease the intracranial pressureand reduce its rebound. This research based on the symptoms of headache,dizziness, nausea and vomiting appear on patients after thyroid resection,focuses on the combined application of mannitol and small dose ofdexamethasone to reduce symptoms of headache, dizziness, nausea andvomiting, to provide a strong theoretical basis for clinical application.Method: Choosing thyroid surgery patients in hospital from August, 2010to November,2011. Excluding cases below: age not in the rangefrom18to65years; have headache history; have the vertigo history; haveserious hypertention history; have severe diabetes; have spondylopathyhistory; have allergy or taboo to mannitol or dexamethasone, or similardrugs; have smoking history; have cerebrovascular disease; the operationtime exceed2.5hours.100patients in total, which includes29male and71female, average age is48.78±11.57years. Numbered them accordingto the order of admission and divided into two groups by random. Thefirst group was given250ml20%mannitol and10mg dexamethasonewhile the second with nothing. After the surgery, observed the symptomsof headache, dizziness, nausea and vomiting in24hours and48hours, andgraded those symptoms by VAS(Visual Analogue Scale). The specificmethod was drawing a line with10cm length. One side of this line signedas0, which represents headache and dizzness or no nausea and vomiting;another side signed as10, which represents serious headache and dizznessor nausea and vomiting; the middle part represents headache anddizziness or nausea and vomiting in defferent degrees. The patientsmarked on this line according to their own feeling to show the degree ofheadache and dizziness or nausea and vomiting. Recorded and assessedevery case,0as none, below4cm as mild,4-7cm as moderate, and7cm assevere. The general condition was recorded in the case data, such asgender, age, basic diseases, the way of operation and anesthesia,operation time, etc. Statistical software SPSS13.0helped to process data;measurement data was marked as x±s and enumeration data aspercentage; data analysis with t test,Chi-square test and Mann-WhitneyU test; P<0.05as significant difference.Result:These two groups were comparable since there was nosignificant difference between these two groups on their age,gender,anesthesia method and disease category (P>0.05). Compared theheadache, dizziness degree of the first group to the second group at the24^thhour and48^thhour after operation, Z=-2.699, P=0.007；Z=-2.757, P=0.006,(p<0.05), there was obvious difference between these twogroups. Compared the nausea and vomiting degree of the first group tothe second group at the24th hour and48th hour after operation, Z=-2.523,P=0.012；Z=-3.141,P=0.002,(p<0.05), there was obvious differencebetween these two groups.Conclusion:1The reason of the symptoms of headache, dizziness, nausea andvomiting after thyroidectomy is various. Reducing intracranial pressure isan important step to reduce or eliminate this complication.2The combined application of mannitol and small dose ofdexamethasone can effectively reduce symptoms of e headache, dizziness,nausea and vomiting, and lighten patient agony.That can be selectivelyapply in clinical.