不同剂量地塞米松对腹腔镜阑尾炎切除术术后快速康复的临床研究

Clinical study of different doses of dexamethasone on rapid recovery after laparoscopic appendectomy

目的观察不同剂量地塞米松对腹腔镜阑尾炎切除患者术后快速康复的影响。方法 92例行腹腔镜下阑尾切除术患者,随机分为对照组(32例)和观察组(60例)。观察组根据地塞米松剂量不同分为低剂量组和高剂量组,各30例。对照组给予快速康复外科(ERAS)治疗方案,低剂量组在对照组基础上于麻醉诱导前静脉注射地塞米松5 mg,高剂量组在对照组基础上于麻醉诱导前静脉注射地塞米松10 mg。比较三组患者的术前、术后24 h视觉模拟评分法(VAS)评分、术后进食时间、术后肛门排气/排便时间、住院时间、住院费用及术后并发症发生情况。结果术后24 h,低剂量组和高剂量组VAS评分均低于对照组,差异均具有统计学意义(P<0.05);而低剂量组和高剂量组比较差异无统计学意义(P>0.05)。低剂量组和高剂量组患者术后进食时间、术后肛门排气/排便时间分别为(35.64±5.57)、(31.01±5.49)h和(32.64±5.51)、(30.69±6.59)h,明显短于对照组的(40.02±5.59)、(35.25±3.59)h,差异具有统计学意义(P<0.05)。高剂量组术后进食时间短于低剂量组,差异具有统计学意义(P<0.05);而高剂量组术后肛门排气/排便时间短于低剂量组,但差异无统计学意义(P>0.05)。低剂量组和高剂量组患者术后并发症发生率分别为16.67%、10.00%,均低于对照组的25.00%,但差异无统计学意义(P>0.05)。低剂量组和高剂量组患者的住院时间短于对照组,差异具有统计学意义(P<0.05)。高剂量组患者的住院时间长于低剂量组,但差异具无统计学意义(P>0.05)。而三组患者住院费用比较差异无统计学意义(P>0.05)。结论围手术期静脉注射地塞米松,可加速腹腔镜阑尾切除的患者术后快速康复。但不同剂量地塞米松的应用效果仍需进一步大样本研究。

Objective To observe the effect of different doses of dexamethasone on rapid recovery after laparoscopic appendectomy.Methods A total of 92 patients with laparoscopic appendectomy were randomly divided into control group(32 cases)and observation group(60 cases).The observation group were divided by different doses of dexamethasone in low-dose group and high-dose group,with 30 cases in each group.The control group received enhanced recovery after surgery(ERAS)regimen,low-dose group received intravenous injection of dexamethasone 5 mg before induction of anesthesia on the basis of the control group,and high-dose group received intravenous injection of dexamethasone 10 mg before induction of anesthesia on the basis of the control group.Comparison were made on visual analogue score(VAS)before and 24 h after operation,feeding time after operation,anal exhaust/defecation time,hospitalization time,hospitalization expenses and complications after operation among three groups.Results At 24 h after operation,low-dose group and high-dose group had lower VAS score than the control group,and the difference was statistically significant(P<0.05).But there was no statistically significant difference in low-dose group and high-dose group(P>0.05).Low-dose group and high-dose group had obviously shorter feeding time after operation and anal exhaust/defecation time respectively as(35.64±5.57),(31.01±5.49)h and(32.64±5.51),(30.69±6.59)h than(40.02±5.59)and(35.25±3.59)h in the control group.Their difference was statistically significant(P<0.05).High-dose group had shorter feeding time after operation than low-dose group,and the difference was statistically significant(P<0.05).High-dose group had shorter exhaust/defecation time after operation than low-dose group,but the difference was not statistically significant(P>0.05).Low-dose group and high-dose group had lower incidence of complications after operation respectively as 16.67%and 10.00%than 25.00%in the control group,but the difference was not statistically significant(P>0.05).Low-dose group and high-dose group had shorter hospitalization time than the control group,and the difference was statistically significant(P<0.05).High-dose group had longer hospitalization time than low-dose group,but the difference was statistically significant(P>0.05).Three groups had no statistically significant difference in hospitalization costs(P>0.05).Conclusion Intravenous injection of dexamethasone during perioperative period can accelerate the rapid recovery of patients after laparoscopic appendectomy.However,the application effect of different doses of dexamethasone still needs further large sample study.