乌司他丁联合地塞米松对结直肠癌腹腔镜术后恶心呕吐(PONV)和肝肾功能的影响

Effect of ulinastatin combined with dexamethasone on postoperative nausea and vomiting (PONV) and hepatic and renal functions after laparoscopic surgery for colorectal cancer

目的探讨乌司他丁联合地塞米松对结直肠癌患者腹腔镜术后恶心呕吐(Postoperative nausea and vomiting,PONV)及肝肾功能的影响。方法收集腹腔镜手术治疗的结直肠癌患者156例,根据随机数字表法将患者分为对照组(C组,生理盐水组),试验组:U组(乌司他丁组)、D组(地塞米松组)和UD组(乌司他丁和地塞米松联用组),每组39例。C组常规麻醉,D组术前给予地塞米松,U组术前给予乌司他丁,UD组术前给予乌司他丁和地塞米松联用。测定四组患者气腹前10 min (T_0)、气腹后第1天(T_1)、术后第3天(T_2)、第5天(T_3)、第7天(T_4)血中ALT、AST、BUN、Scr浓度;于术后6 h、24 h、72 h观察并记录各组患者PONV发生情况。结果 T_0时试验组和对照组组间AST、ALT、BUN、Scr比较差异无统计学意义(P>0.05);T_1、T_2、T_3、T_4时,四组AST、ALT、BUN、Scr均在正常范围内。T_1、T_2时,U组和D组AST、ALT水平高于UD组,差异具有统计学意义(P<0.05),而U组与D组AST、ALT比较差异无统计学意义(P>0.05);U组与UD组AST、ALT随时间变化的趋势不同(P<0.05)。D组BUN、Scr与C组比较差异无统计学意义(P>0.05),同时,U组和UD组BUN、Scr均显著低于C组(P<0.05)。C组PONV发生率显著高于U组、UD组(P<0.05),但U组与UD组PONV发生率比较差异无统计学意义(P>0.05)。结论单用时,乌司他丁与地塞米松均对肝脏功能产生保护作用,但是否具有协同作用仍需进一步研究;地塞米松能够减少结直肠癌患者腹腔镜PONV的发生,而乌司他丁并不能够加强地塞米松单用对PONV发生率的降低作用。

Objective To investigate the effect of ulinastatin combined with dexamethasone on postoperative nausea and vomiting(PONV)and hepatic and renal function in patients with laparoscopic operation for colorectal cancer.Methods Totally 156 patients with colorectal cancer receiving laparoscopic surgery were collected and divided into 4 groups by randomized numerical table method.Grouping situation was as follows:control group(group C,saline group)and trial groups,including group U(ulinastatin group),group D(dexamethasone group)and group UD(ulinastatin combined with dexamethasone group).Each group had 39 cases.Group C was given routine anesthesia,Group D was pretreated with dexamethasone by intramuscular injection,while Group U was given ulinastatin before surgery and group UD was given ulinastatin combined with dexamethasone).The concentrations of ALT,AST,BUN and Scr of the four groups were measured at T0(10 minutes before pneumoperitoneum),T1(1st day),T2(3rd day),T3(5th day)and T4(7th day).Incidence of PONV was observed and recorded at 6 h,24 h and 72 h after surgery.Results There were no significant differences in AST,ALT,BUN or Scr between control group and trial groups at T0(P>0.05).The levels of AST,ALT,BUN and Scr in the four groups were within the normal range at T1,T2,T3 and T4.The AST and ALT levels of group U and group D were higher than those of group UD at T1 and T2(P<0.05),while there were no significant differences between group U and group D(P>0.05).The time trend of AST and ALT were significantly different between group U and group UD.There was no difference in BUN or Scr between group D and group C(P>0.05),while the two indexes in group U and group UD were lower than those in group C(P<0.05).The incidence of PONV in group C was significantly higher than that in group U and UD(P<0.05),but there was no significant difference between group U and group UD(P>0.05).Conclusion Both ulinastatin and dexamethasone have protective effects on liver function independently,however,further studies are needed on the synergistic effect;dexamethasone can reduce the incidence of laparoscopic PONV in patients with colorectal cancer,but ulinastatin can not increase this effect.