不同剂量地塞米松对腹腔镜胆囊切除术患者术后恶心呕吐预防效果的临床观察

Study of dexamethasone in preventing postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy

目的探讨地塞米松预防腹腔镜胆囊切除术(LC)术后恶心呕吐(PONV)的效果,并寻找应用地塞米松的最小有效剂量。方法选择150例患者,随机分为5组(n=30)。分别于麻醉诱导前即刻静脉注射地塞米松0.05mg/kg(D0.05组)、地塞米松0.1mg/kg(D0.1组)、地塞米松0.2mg/kg(D0.2组)、恩丹西酮4mg(O组)和同容积生理盐水(S组)。观察记录手术后0～24h内患者PONV情况、抗恶心呕吐药物使用情况。结果 D0.1组、D0.2组与S组比较:术后0～24h内总的PONV的发生率明显降低,差异具有统计学意义(P<0.01),总需要抗恶心呕吐药物治疗的患者比例亦降低,差异具有统计学意义(P<0.05)。D0.1组与D0.2组比较差异没有统计学意义(P>0.05)。D0.05组S组比较差异没有统计学意义(P>0.05)。D0.1组与D0.05组比较,术后0～24h时内总的PONV的发生率明显降低,差异具有有统计学意义(P<0.01),需要抗恶心呕吐药物治疗的患者比例亦降低,差异具有统计学意义(P<0.05)。D0.1组与O组比较:术后0～24h内PONV发生率降低(P<0.05)。结论静脉注射地塞米松0.1mg/kg能有效地预防LC后PONV发生。

Objective To investigate the efficacy of intravenous of different dosages of dexamethasone in preventing postoperative nausea and vomiting in patients undergoing LC.Methods 150 cases ASA physical status I and II patients,aged from 18 to 65 years old.The patients were randomly divided into five groups （n=30 each）.Patients receive dexamethasone 0.05 mg/kg（D0.05 group）,0.1 mg/kg（D0.1 group）,0.2 mg/kg（D0.2 group）,ondansetron 4 mg （O group）,and saline （S group） before the induction of general anesthesia.All patients received a standardized anaesthetic and surgical treatment.the episodes of nausea and vomiting and antiemetic requirements were recorded during 0～24 h respectively after the operation.Results Groups D0.1 and D0.2 were significantly different from Group S during 0～24 h after operation in the incidences of PONV （respectively P0.05）.The efficacy of Groups D0.05 for preventing postoperative nausea and vomiting is poor.Groups D0.05 and S were not significant（P〉0.05）.Groups D0.1 were significantly different from Group D0.05 during 0～24 h after operation in the incidences of PONV （P〈0.01）,and the proportions of patients requiring rescue antiemetics （P〈0.05）.Conclusion Dexamethasone 0.1 mg/kg was an effective dose to preventing PONV in patients undergoing laparoscopic cholecystectomy.