地塞米松与托烷司琼预防腹腔镜手术后恶心及呕吐作用的性别差异研究

Sex-specific Difference in the Effects of Dexamethasone versus Tropisetron for the Prevention of PONV in Patients with Laparoscopic Surgery

目的探讨地塞米松、托烷司琼对腹腔镜手术后恶心、呕吐(PONV)预防作用的性别差异。方法选取2014年12月—2015年12月于天津医科大学总医院拟行腹腔镜手术(胆囊切除术、阑尾切除术、子宫切除术及附件切除术)患者382例为研究对象,采用随机数字表法,将不同性别患者随机分为男性地塞米松(MD)组、男性托烷司琼(MT)组、男性对照(MC)组、女性地塞米松(FD)组、女性托烷司琼(FT)组、女性对照(FC)组。排除术中、术后不符者22例,各组均纳入60例。MD、FD组分别于麻醉诱导前即刻静脉滴注地塞米松0.15 mg/kg,MT、FT组分别于麻醉诱导前即刻静脉滴注托烷司琼5 mg,MC、FC组于麻醉诱导前即刻静脉滴注5 ml 0.9%氯化钠溶液。记录从拔管开始至术后24 h各组患者发生恶心、呕吐的例数及其分级,需使用止吐药物治疗的例数,以及术后首次恶心、呕吐发生时间。结果术后24 h内,MD、MT组PONV分级、总PONV发生率、使用止吐药物比例均低于MC组(P<0.01),FT组PONV分级、总PONV发生率、使用止吐药物比例均低于FC组(P<0.01);FD组与FC组PONV分级、总PONV发生率、使用止吐药物比例比较,差异无统计学意义(P>0.01)。术后24 h内,MD、MT组术后首次恶心、呕吐发生时间长于MC组(P<0.05),FT组术后首次恶心、呕吐发生时间长于FC组(P<0.05);FD组与FC组术后首次恶心、呕吐发生时间比较,差异无统计学意义(P>0.05)。结论腹腔镜手术麻醉诱导前应用地塞米松预防PONV,可以降低男性患者PONV发生率,并延长男性患者术后首次恶心、呕吐发生时间,但对女性患者预防PONV的效果不明显。而托烷司琼可同时降低男性、女性患者PONV发生率,且延长术后首次恶心、呕吐发生时间。

Objective To investigate the sex-specific difference in the effects of dexamethasone and tropisetron for the prevention of postoperative nausea and vomiting（ PONV） in patients with laparoscopic surgery. Methods The initially enrolled participants were 382 consecutive patients who underwent the laparoscopic surgery（ laparoscopic cholecystectomy or laparoscopic appendectomy or laparoscopic hysterectomy and annexectomy） in Tianjin Medical University General Hospital from December 2014 to December 2015. After excluding 22 cases who did not meet the inclusion criteria during and after the surgery,the rest 360 cases were equally divided into male dexamethasone（ MD） group, male tropisetron（ MT） group, male control（ MC） group,female dexamethasone（ FD） group,female tropisetron（ FT） group,female control（ FC） group. Immediately before anesthetic induction,MD and FD groups received intravenous drip of dexamethasone 0. 15 mg/kg,MT and FT groups received intravenous drip of tropisetron 5 mg,and MC and FC groups received intravenous drip of 0. 9% sodium chloride solution5 ml. The incidence and degree of PONV,prevalence of treatment with antiemetic drugs,the first-occurrence time of PONV from the extubation to within 24 h after the surgery were recorded in all the groups. Results Within 24 h after the surgery,MC group had more severe PONV and higher overall incidence of PONV and higher prevalence of treatment with antiemetic drugs than both MD and MT groups（ P〈0. 01）; FC group had more severe PONV and higher overall incidence of PONV and higher prevalence of treatment with antiemetic drugs than FT group（ P〈0. 01）; the degree and overall incidence of PONV and prevalence of treatment with antiemetic drugs did not differ significantly between FD and FC groups（ P〈0. 01）; PONV occurred earlier in MC group than in MD and MT groups（ P〈0. 05）,and it occurred earlier in FC group than in FT group（ P〈0. 05）,but the first-occurrence time of PONV was similar in FD and FC groups（ P〈0. 05）. Conclusion The incidence of PONV can be reduced and the first-occurrence time of PONV can be delayed by intravenous drip of dexamethasone before anesthetic induction in only males with laparoscopic surgery, whereas similar effects like those described above can be achieved by intravenous drip of tropisetron before anesthetic induction in both males and females with laparoscopic surgery.