甲强龙与地塞米松复合托烷司琼对甲状腺术后恶心呕吐高危患者的预防效果比较

Comparison of the effects of methylprednisolone and dexamethasone individually combined with tropisetron on the prevention of postoperative nausea and vomiting of high risk in patients with thyroid surgery

目的比较甲强龙与地塞米松分别复合托烷司琼预防甲状腺术后恶心呕吐（PONV）高危患者的效果。方法择期行甲状腺手术的PONV高危患者160例，采用随机数字表法分为四组：甲强龙复合托烷司琼组（MT组）在手术结束时静脉注射甲强龙40mg和托烷司琼5mg；地塞米松复合托烷司琼组（DT组）在麻醉诱导前静脉注射地塞米松7．5mg和手术结束时静脉注射托烷司琼5mg；托烷司琼组（T组）在手术结束时静脉注射托烷司琼5mg；对照组（C组）静脉注射等容量生理盐水。记录术后24h内PONV的发生率、严重程度和不良反应的发生情况。结果与DT组比较，MT组术后0—2h、2～6h时段PONV发生率明显降低（P〈0．05），术后2h时恶心呕吐VAS评分明显降低（P〈0．05）；与C组比较，MT组和DT组术后0～24h时段PONV发生率和恶心呕吐VAS评分均明显降低（P〈0．05），T组术后2—6h、6—12h时段PONV发生率明显降低（P〈0．05），术后6、12h时恶心呕吐VAS评分明显降低（P〈0．05）；与C组比较，MT组和DT组头痛发生率明显降低（P〈0．05），T组眩晕发生率明显增高（P〈0．05），MT组和DT组不良反应发生率差异无统计学意义（P〉0．05）。结论甲强龙复合托烷司琼对PONV高危患者术后6h内恶心呕吐的预防效果优于地塞米松复合托烷司琼。

Objective To compare the effects of methylprednisolone and dexamethasone individually combined with tropisetron on the prevention of postoperative nausea and vomiting （PONV） of high risk in patients with thyroid surgery. Methods One hundred and sixty patients of high risk of postoperative nausea and vomiting scheduled for radical operation of thyroid with general anesthesia were randomly divided into four groups with 40 cases each. Four groups of the patients were intravenously injected methylprednisolone 40 mg plus tropisetron 5 mg at the end of the operations （ group MT）, dexamethasone 7. 5 mg before anesthesia induction, and tropisetron 5 mg at the end of the operations （group DT）, tropisetron 5 mg at the end of the operations （ group T）, and normal saline （ group C）. Incidence and severity of nausea, vomiting and adverse reactions were recorded during 24 hours after end of the operations. Results Compared to group DT, the incidences of PONV during the 0 ～ 2 h and 2 ~ 6 h, and the visual analogue scale （VAS） of PONV at 2 h after the operations in group MT were significantly lower （P 〈 0. 05）. Compared to group C, the incidences of PONV and VAS score during the 0 ～ 24 h after the operations in group MT and group DT were significantly lower （ P 〈0. 05 ）, the incidences of PONV during the 2 ～ 6 h and 6 ～ 12 h after the operations, and VAS score of PONV at 6 h and 12 h after the operations in group T were significantly lower （P 〈0. 05）.Compared to group C, incidences of headache in group MT and group DT were significantly lower （P 〈 0. 05 ）, and incidence of swim in group T was also significantly lower （ P 〈 0. 05 ）. Incidence of adverse reactions in group MT and group DT were no significant difference. Conchtsions Preventive effect of methylprednisolone combined with tropisetron for PONV in high - risk patients within 6 hours after thyroid surgery was significantly better than that of dexamethasone combined with tropisetron.