静脉与腹膜腔内注射地塞米松对预防和减少妇科腹腔镜术后恶心呕吐的效果比较

Effect comparison of intravenous and intraperitoneal injection of dexamethasone on prevention and reduction of postoperative nausea and vomiting after gynecological laparoscopic surgery

目的比较妇科腹腔镜术后静脉注射与腹膜腔内注射地塞米松两种方式对预防和减少术后恶心呕吐(PONV)的效果。方法 80例行妇科腹腔镜择期手术女性患者,按照随机数字表法分为IV组和IP组,每组40例。IV组患者给予静脉注射地塞米松, IP组患者给予腹膜腔内注射地塞米松。比较两组患者术后第1个24 h PONV发生情况、止吐情况、视觉模拟评分法(VAS)评分、哌替啶消耗量及围术期不良事件发生情况。结果术后第1个24 h, IV组患者恶心发生率为27.5%,高于IP组的7.5%,差异具有统计学意义(P<0.05);两组干呕、呕吐、需要止吐药情况、止吐药总剂量比较差异无统计学意义(P>0.05)。IP组患者不良事件发生率为7.5%,低于IV组的27.5%,差异具有统计学意义(P<0.05);两组患者眩晕、头痛、劲肩痛、晕厥、伤口延迟愈合发生率比较差异无统计学意义(P>0.05)。术后第1个24 h, IP组患者VAS评分低于IV组,哌替啶消耗量少于IV组,但差异无统计学意义(P>0.05)。结论在妇科腹腔镜手术后给予腹膜腔内注射8 mg地塞米松可以减少PONV发生情况。

Objective To compare the effect of intravenous and intraperitoneal injection of dexamethasone on prevention and reduction of postoperative nausea and vomiting(PONV) after gynecological laparoscopic surgery. Methods A total of 80 female patients undergoing elective gynecological laparoscopic surgery were divided into IV group and IP group according to random number table method, with 40 cases in each group. IV group received intravenous injection of dexamethasone, and IP group received intraperitoneal injection of dexamethasone. Comparison was made on occurrence of PONV at the first 24 h after operation, antiemetic situation, visual analogue scale(VAS) score, pethidine consumption and occurrence of perioperative adverse events between the two groups. Results At the first 24 h after operation, the incidence of nausea was 27.5%, which was higher than 7.5% in IP group, and the difference was statistically significant(P<0.05). There was no statistically significant difference in situation of nausea, vomiting and the need for antiemetic drugs and total dose of antiemetic between the two groups(P>0.05). The incidence of adverse events was 7.5% in IP group, which was lower than 27.5% in IV group, and the difference was statistically significant(P<0.05). There was no statistically significant difference in incidence of vertigo, headache, neck and shoulder pain, syncope and delayed wound healing between the two groups(P>0.05). At the first 24 h after operation, the VAS score in IP group was lower than that in IV group, and pethidine consumption was less than that in IV group, but the difference was not statistically significant(P>0.05). Conclusion Intraperitoneal injection of 8 mg dexamethasone after gynecological laparoscopic surgery can reduce the incidence of PONV.