腹主动脉瘤EVAR术后联合应用地塞米松对患者术后应激反应、术后并发症的影响

Effects of dexamethasone combined with EVAR on postoperative stress response and postoperative complications in patients with abdominal aortic aneurysm

目的 探究腹主动脉瘤EVAR术后联合应用地塞米松对患者术后应激反应、术后并发症的影响。方法收集2018年5月至2021年5月湖南省人民医院收治腹主动脉瘤且行腹主动脉瘤腔内修复术(EVAR)患者92例进行回顾性研究分析,并根据期间患者所采取的治疗方案对其进行分组整理,分别为对照组、研究组,每组各46例,其中对照组采用EVAR治疗,研究组则在接受EVAR治疗后联用地塞米松。比较两组的手术效果、术后患者应激反应指标[皮质醇、前列腺素E2(PGE2)、促肾上腺皮质激素(ACTH)、促肾上腺皮质激素释放激素(CRH)]、并发症和生存质量。结果研究组术后24 h视觉模拟评分法(VAS)评分、术后72 h血小板下降数量分别为(3.31±0.64)分、(21.18±2.40)×10^(9)L,均低于对照组[(4.82±0.76)分、(30.84±3.41)×10^(9)L],术后首次下床活动时间、住院时间分别为(25.28±2.11) h、(7.75±1.42) d,均短于对照组[(29.85±2.47) h、(10.04±1.63) d],差异均有统计学意义(P <0.05)。术后24 h,研究组皮质醇、PGE2、ACTH、CRH水平为(138.46±12.75) ng/L、(270.38±20.75) pg/m L、(24.79±4.83) ng/m L、(44.11±8.69) pg/m L,均低于对照组[(153.47±15.92) ng/L、(309.75±24.80) pg/m L、(31.94±6.13) ng/m L、(53.64±10.55) pg/m L],差异均有统计学意义(P <0.05)。研究组术后近期并发症发生率为8.70%,远期并发症发生率为6.52%,均较低于照组(39.13%、28.26%),差异有统计学意义(P <0.05)。术后6个月研究组世界卫生组织生命质量测定量表(WHOQOL-100)各维度评分均高于对照组,差异均有统计学意义(P <0.05)。结论 腹主动脉瘤EVAR术后联合应用地塞米松效果满意,不仅能缓解术后应激反应,还能减少并发症发生率,提高患者生存质量,值得推广。

Objective To investigate the effect of dexamethasone combined with EVAR on postoperative stress response and postoperative complications of patients with abdominal aortic aneurysm.Methods A retrospective study was performed on 92 patients with abdominal aortic aneurysm who underwent endovascular repair of abdominal aortic aneurysm( EVAR) in Hunan Provincial People’s Hospital from May 2018 to May2021.And they were divided into control group and study group according to the treatment plan adopted during the period,with 46 patients in each group.The control group was treated with EVAR,while the study group was treated with dexamethasone after EVAR.The surgical outcomes,postoperative patient stress response indicators [cortisol,prostaglandin E2( PGE2),adrenocorticotropic hormone( ACTH),corticotropin-releasing hormone( CRH) ],complications,and quality of life were compared between the two groups.Results The visual analogue scale( VAS) score at24 hours after operation and the number of platelets at 72 hours after operation in the study group were( 3.31 ± 0.64) points and( 21.18 ± 2.40)× 10^(9)L,which were lower than those in the control group [( 4.82 ± 0.76) points,( 30.84 ± 3.41) × 10^(9)L],and the time of first ambulation after operation,the length of hospital stay were( 25.28 ± 2.11) h,( 7.75 ± 1.42) d,which were shorter than those in the control group [( 29.85± 2.47) h,( 10.04 ± 1.63) d],and the differences were statistically significant( P < 0.05).At 24 hours after operation,the levels of cortisol,PGE2,ACTH,and CRH in the study group were( 138.46 ± 12.75) ng/L,( 270.38 ± 20.75) pg/mL,( 24.79 ± 4.83) ng/mL,and( 44.11 ± 8.69) pg/mL,which were lower than those in the control group [( 153.47 ± 15.92) ng/L,( 309.75 ± 24.80) pg/mL,( 31.94 ±6.13) ng/m L,( 53.64 ± 10.55) pg/m L],the differences were statistically significant Academic significance( P < 0.05).the incidence of short-term complications in the observation group was 8.70%,and the incidence of long-term complications was 6.52%,which were lower than 39.13% and 28.26% in the control group( P < 0.05);the scores of all dimensions of the World Health Organization Quality of life scale( WHOQOL-100) in the observation group were higher than those in the control group 6 months after operation( P < 0.05).Conclusion The effect of combined application of dexamethasone after EVAR for abdominal aortic aneurysm is satisfactory.It can not only alleviate the postoperative stress response,but also reduce the incidence of complications and improve the quality of life of patients.It is worth popularizing.