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[1]高炟鹏,郭宪,余志阳,等.术前单次地塞米松对炎症性肠病术后疼痛和恶心呕吐的影响[J].医学研究与战创伤救治(原医学研究生学报),2021,23(6):570-575.[doi:10.3969/j.issn.1672-271X.2021.06.003]
　GAO Da-peng,GUO Xian,YU Zhi-Yang,et al.Effects of single dexamethasone on postoperative pain, nausea and vomiting in patients with inflammatory bowel disease[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2021,23(6):570-575.[doi:10.3969/j.issn.1672-271X.2021.06.003]
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术前单次地塞米松对炎症性肠病术后疼痛和恶心呕吐的影响()
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《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第23卷
期数:
2021年6期
页码:
570-575
栏目:
临床研究
出版日期:
2021-12-15

文章信息/Info

Title:
Effects of single dexamethasone on postoperative pain, nausea and vomiting in patients with inflammatory bowel disease
作者:
高炟鹏; 郭宪; 余志阳; 袁亮; 唐君; 张利东; 嵇晴
作者单位：210002南京，南京大学医学院附属金陵医院（东部战区总医院）麻醉科（高炟鹏、郭宪、余志阳、袁亮、唐君、张利东、嵇晴）
Author(s):
GAO Da-peng;  GUO Xian;  YU Zhi-Yang;  YUAN Liang;  TANG Jun;  ZHANG Li-dong;  JI Qing
(Department of Anesthesiology, Jinling Hospital Affiliated to Medical School of Nanjing University/General Hospital of Eastern Theater Command, PLA, Nanjing 210002, Jiangsu, China)
关键词:
地塞米松; 炎症性肠病; 术后疼痛; 恶心呕吐
Keywords:
dexamethasone;  inflammatory bowel disease;  postoperative pain;  nausea and vomiting
分类号:
R574
DOI:
10.3969/j.issn.1672-271X.2021.06.003
文献标志码:
A
摘要:
目的探讨术前单次10 mg地塞米松对炎症性肠病（IBD）患者术后疼痛与恶心呕吐的有效性与安全性。方法回顾性分析东部战区总医院2018年1月至2019年12月诊断为IBD（溃疡性结肠炎和克罗恩病）行手术治疗的180例患者的临床资料，按是否术前应用10 mg地塞米松分成对照组与地塞米松组，每组90例。地塞米松组：术前静脉输注地塞米松10 mg；对照组：术前未应用任何激素。对比2组患者术后恶心呕吐发生率及严重程度、止吐药物剂量、患者自控镇痛（PCIA）有效次数、总次数及额外应用镇痛药物剂量、视觉模拟疼痛评分法(VAS)评分、白细胞（WBC）、中性粒细胞百分数（NEU）、C-反应蛋白（CRP）、白细胞介素-6（IL-6）、降钙素原（PCT）、白蛋白水平、住院时间、住院费用及住院期间并发症。结果地塞米松组术后第1、3、5天的VAS评分与对照组相比均明显下降（P＜0.05）。血液学指标：地塞米松组术后第1天的WBC低于对照组（P＜0.05）。地塞米松组术后第1、3、5天的NEU、CRP、IL-6与对照组相比均明显下降（P＜0.05）。地塞米松组术后第1、3天的PCT与对照组相比明显下降（P＜0.05）。地塞米松组术后恶心呕吐发生率18.9%，低于对照组的32.2%（P=0.040），且地塞米松组术后昂丹司琼使用例数低于对照组[7(7.8%) vs 16(17.8%),P=0.044]。地塞米松组术后PCIA总按压12(5~22) 次/24 h，低于对照组的19(10~29) 次/24 h（P<0.001），地塞米松组术后PCIA有效按压6.0 (2.0~11.0) 次/24 h，低于对照组的8.5(4.8~14.3) 次/24 h（P=0.003）。地塞米松组住院时间16(13~21) d，较对照组19(14~25) d缩短（P=0.019），且地塞米松组住院费用58 746(40 828~73 767) 元，较对照组62 225(51 173~86 255) 元降低（P=0.010）。2组术后手术相关并发症比较差异无统计学意义（P>0.05）。结论术前单次应用地塞米松10 mg可有效降低IBD患者炎症因子水平，缓解术后疼痛和降低术后恶心呕吐的发生率，缩短住院时间，且不增加并发症。
Abstract:
ObjectiveTo investigate the efficacy and safety of preoperative single dose of 10 mg dexamethasone on postoperative pain, nausea and vomiting in patients with IBD(inflammatory bowel disease, IBD).MethodsA total of 180 patients who were admitted into the General Hospital of Eastern Theater Command with IBD (Ulcerative colitis and Crohn’s disease) from January 2018 to December 2019 were retrospectively analyzed.They were divided into control group (90 cases) and dexamethasone group (90 cases) according to whether dexamethasone was used before operation.Before anesthesia, dexamethasone group received an intravenous infusion of dexamethasone 10 mg, and the patients in the control group were not given any hormone before operation. The incidence and severity of postoperative nausea and vomiting, the dosage of antiemetic drugs, the effective times and total times of patients-controlled analgesia (PCIA), the dosage of additional analgesics, VAS score, leukocyte (WBC), C-reactive protein (CRP), interleukin-6 (IL-6), procalcitonin (PCT), albumin, hospitalization time, hospitalization expenses and complications were recorded in the two groups.ResultsThe VAS score of dexamethasone group on the 1st, 3rd and 5th day after operation was significantly lower than that of the control group (P＜0.05). Hematological indexes: WBC on the first day after operation in dexamethasone group was lower than that in control group (P＜0.05). NEU, CRP and IL-6 in the dexamethasone group decreased significantly compared with the control group on the 1st, 3rd and 5th day after operation (P＜0.05). PCT in dexamethasone group decreased significantly on the 1st and 3rd day after operation compared with the control group (P＜0.05). The incidence of nausea and vomiting in dexamethasone group was 17 (18.9%) lower than that of control group 29 (32.2%) (P=0.040), and the number of ondansetron use in dexamethasone group was lower than that in control group [7(7.8%) vs 16(17.8%), P=0.044]. The total PCIA pressure of dexamethasone group was 12 (5-22) times / 24 h, which was lower than that of control group 19 (10-29) times / 24 h (P<0.001), and the effective compression of PCIA in dexamethasone group was 6.0 (2.0-11.0) times / 24 h lower than that of the control group 8.5 (4.8-14.3) times / 24 h (P=0.003). The hospitalization time of dexamethasone group was 16 (13-21) days, which was shorter than that of control group 19 (14-25) days (P=0.019), and the cost of hospitalization in dexamethasone group was 58 746 (40 828-73 767) yuan lower than that of control group 62 225 (51 173-86 255) yuan (P=0.010). There was no significant differences in postoperative complications during hospitalization (P>0.05).ConclusionA single dose of dexamethasone 10 mg before operation can effectively reduce the level of inflammatory factors in patients with inflammatory bowel disease, relieve postoperative pain and reduce the incidence of postoperative nausea and vomiting, shorten hospital stay, and do not increase complications.

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备注/Memo

备注/Memo:
基金项目：中国博士后基金特别资助项目（2016T91014）
更新日期/Last Update: 2021-12-15