小剂量地塞米松对体外循环心内直视手术术后恢复的影响

Effect of small-dose dexamethasone on recovery scores after cardiac surgery

目的应用术后恢复质量QoR-40评分系统,探讨小剂量地塞米松对体外循环心内直视手术术后恢复的影响。方法体外循环下单瓣膜置换患者80例,随机分为地塞米松组(D组)和对照组(C组),每组40例。D组术中给予地塞米松20 mg(4 mL)、C组给予生理盐水4 mL。术后应用QoR-40对恢复质量及恶心呕吐、疲劳程度、寒战等进行评分。结果 D组在术后第1天及第2天,身体舒适、情绪状态、疼痛及总分上均优于C组(P<0.01)。D组术后第1天及第2天疲劳水平均较C组轻(P<0.05);D组恶心呕吐发生率术后2 d均低于C组(P<0.01),且前者术后第1天恶心呕吐水平显著低于后者(P<0.05)。D组术后第1天及第2天寒战比率均小于C组(P<0.01)。结论小剂量地塞米松能够明显提高体外循环心内直视手术术后恢复质量。

Objective To determine the effect of small-dose dexamethasone therapy on patient-perceived quality of recovery（QoR）scores in elective cardiac surgical patients.Methods 80 patients undergoing single valve replacement surgery with CPB were randomly divided into two groups,40 patients in each group.Patients of the two groups were randomized to receive either dexamethasone（group D,20 mg）or placebo（group C,saline 4 mL）.The QoR was assessed using the QoR-40 scoring system.Secondary outcome measures assessed in the postoperative period included nausea,vomiting,fatigue,shivering.Results Global QoR-40 scores in group D were higher than those of control group on POD1 and POD 2（P〈0.01）.In group D,improved QoR was observed in the QoR-40 dimensions of emotional state,physical comfort and pain（P〈0.01）.The incidences or severity of postoperative fatigue and shivering reduced in group D（P〈0.01）.Conclusion Patient-perceived postoperative QoR in cardiac surgical patients can be enhanced significantly by small dose dexamethasone.