地塞米松减少术后硬膜外吗啡镇痛引起的恶心呕吐

Decrease in postoperative nausea and vomiting related to epidural morphine analgesia by dexamethasone

目的 :观察地塞米松对减少术后硬膜外吗啡镇痛引起恶心呕吐的作用。方法 :胃癌根治性手术患者 83例 ,随机分成2组 :研究组 (n =42 ) ,术后地塞米松 8mg ,iv ;对照组 (n =41) ,术后给予等量NS。所有患者在手术后均接受硬膜外吗啡镇痛。观察指标 :恶心呕吐、皮肤瘙痒等 ,并进行统计分析。结果 :经 2 4h观察 ,研究组的恶心呕吐发生率比对照组显著减少 (16 6 7%vs48 78% ,P <0 0 0 1) ,研究组呕吐发生率低于对照组 (P <0 0 5 ) ;皮肤瘙痒发生率 2组无统计学差异 (P >0 0 5 ) ;地塞米松对吗啡镇痛无影响 ,与对照组比较 ,P >0 0 5。结论 :地塞米松作为预防性减少硬膜外吗啡镇痛有关恶心呕吐不良反应的有效药物 。

AIM: To observe the effect of dexamethasone (Dex) on the decrease of epidural morphine related postoperative nausea and vomiting. METHODS: Eighty-three patients, who were after radical operation of gastric cancer, were divided into 2 groups. Patients in research group (n=42) received Dex 8 mg, iv, after operation. Patients in control group (n=41) received normal saline. All patients received epidural morphine for analgesia after the surgery. Items which were observed were nausea, vomiting, pruritus, etc, and were analysed and checked. RESULTS: After observing for 24 h, the incidence of nausea and vomiting in research group was lower than that in control group (16.67% vs 48.78%, P<0.001). The incidence of vomiting in research group was lower than that in control group (P<0.05). There was no significant difference in the incidence of pruritus between 2 groups (P>0.05). Dexamethasone did not affect the morphine analgesia and had an ideal analgesic effect. CONCLUSION: Prophylactic dexamethasone may be a valuable drug to reduce PONV related to epidural morphine analgesia. It worth clinical application.