术前给予地塞米松减轻无痛人流患者不良反应效果观察

Observation on effect of preoperati ve administration of DXM in alleviating adverse reactions of patients receiving painless-induced abortion

目的研究术前静脉注射地塞米松对减少无痛人流患者围手术期不良反应的临床效果。方法选择行无痛人流的患者156例,随机分为观察组(A组,n=78)与对照组(B组,n=78),两组均在手术前1 h给予米索前列腺醇0.4 mg舌下含服,术中均采用依托咪酯-丙泊酚联合全凭静脉麻醉。在给予米索前列腺醇前10 min,A组静脉推注地塞米松10 mg,B组给予等量生理盐水;手术结束时,B组静注地塞米松10 mg,A组静注等量生理盐水。观察术前(给予米索前列腺素到手术开始)及术后1 h内,两组患者出现恶心呕吐的例数、程度以及需补用托烷司琼止吐的例数,统计围手术期眩晕、寒战、皮肤潮红/皮疹、头面部水肿、低血压等不良反应发生情况。结果与B组比较,A组术前恶心呕吐的例数、程度和需追加托烷司琼的例数明显较少,且围手术期眩晕,寒战、皮肤潮红/皮疹的发生率也有所下降(P<0.05)。结论术前注射小剂量地塞米松可以显著减轻无痛人流患者围手术期恶心呕吐及其他不良反应。

Objective T o study the clinical effect of preoperative administration of dexamethasone(DXM)in alleviating perioperative adverse reactions of patients receiving painless-induced abortion.Methods A total of 156 patients receiving painlessinduced abortion were randomly divided into an observation group(group A,n=78)and a control group(group B,n=78).Sublingual administration of 0.4 mg misoprostol was performed for both group one hour before the operation.Total intravenous anesthesia(TIVA)with etomidate and propofol was adopted for both group during the operation.Group A and group B were intravenously injected with10 mg DXM and normal saline of the same volume respectively 10 minutes before administration of misoprostol.At the end of the operation,group B and group A were intravenously injected with 10 mg DXM and normal saline of the same volume respectively.Patients in both groups were observed for the number of cases and degree of nausea and vomiting,and the number of cases requiring additional tropisetron to stop vomiting before the operation(from the administration of misoprostol to the start of the operation)and one hour after the operation.Adverse reactions such as dizziness,chill,skin flushing/rash,head and face edema and hypotension were recorded during the perioperative period.Results The number of cases and degree of nausea and vomiting before operation and the number of cases requiring additional tropisetron in group A were significantly less than those in group B.The incidence of perioperative dizziness,chill and skin flushing/rash in group A also declined(P<0.05).Conclusion Preoperative administration of low-dose DXM can significantly alleviate perioperative nausea and vomiting and other adverse reactions in patients receiving painless-induced abortion.