地塞米松预防乳癌患者术后恶心呕吐的有效性和安全性的临床研究

Clinical Research on the Efficacy and Safety of Prophylactic Dexamethasone on Postoperative Nausea and Vomiting in Patients Undergoing Mastectomy

目的：分析地塞米松对接受乳癌根治术的患者术后恶心呕吐、血糖、皮质醇、出血和感染的影响，明确其临床使用的有效性和安全性。方法：将160 例择期全麻下行单侧乳癌改良根治术的女性患者随机分为实验组（地塞米松组，n=80）和对照组（生理盐水组，n=80）。检测两组患者术后第1 天和第3 天血糖和血清皮质醇水平，记录术后1～3天恶心呕吐次数和抗呕吐药物的使用量，比较两组术后1 周内出血和感染的发生情况。结果：实验组患者术后第1 天的恶心发生率显著低于对照组，术后1～2 天的呕吐发生率均显著低于对照组，术后第1 天血清皮质醇较对照组显著降低（P〈0.05）。两组患者术后血糖水平比较无统计学差异（P〉0.05）。术后1 周内，两组患者出血和感染的发生情况比较均无显著性差异（P〉0.05）。结论：地塞米松可有效地预防乳癌改良根治术患者术后恶心呕吐，短暂抑制术后内源性皮质醇水平，不增加患者术后高血糖、出血和感染的风险。

Objective： To investigate the anti-emetic prophylactic effects of dexamethasone on the glucose, serum cortisol, postoperative blood loss and infection, and ensure the efficacy and safety of dexamethasone on postoperative nausea and vomiting （PONV） in patients undergoing mastectomy. Methods： 160 women undergoing selective unilateral modified radical mastectomy with general anesthesia were randomly divided into two groups： the experimental group （dexamethasone group, n=80） and control group （saline group, n=80）. Blood glucose, serum cortisol, episodes of PONV and rescue antiemetics consumption were recorded during the first 3 days after surgery. Blood loss and infection was analyzed during the first week postoperation. Results： On the first day after surgery, the episode of nausea in the experimental group was significantly lower than that of the control group（P〈0.05）. The incidence of vomiting was also much lower in the experimental group than in the control group on the first two days after operation （P〈0.05）. The serum cortisol level of experimental group was significantly lower than that of the control group on the first day postopration. There was no significant difference in the postoperative blood glucose, bleeding and infection between two groups. Conclusion： Dexamethasone could effectively prevent the PONV, transiently suppress the endogenous cortisol level, but did not increase the risk of postoperative hyperglycemia, blood loss and infection in patients undergoing mastectomy.