不同剂量地塞米松用于腹腔镜胆囊或阑尾切除术后恢复质量的对比研究OA
Comparative study on the quality of recovery after laparoscopic cholecystectomy or appendectomy using different doses of dexamethasone
目的 探究不同剂量地塞米松用于腹腔镜胆囊与阑尾切除术后恢复质量的应用价值.方法 选择2022年7月至2024年7月天津市第一医院拟行腹腔镜手术患者 123 例,年龄≥18岁,美国麻醉医师协会分级Ⅱ或Ⅲ级.采用随机数字表法将患者分为对照组(n=41)、低剂量组(n=41)、高剂量组(n=41).三组均采用全身麻醉,对照组麻醉诱导前采用等容量生理盐水,低剂量组麻醉诱导前采用5mg地塞米松,高剂量组麻醉诱导前采用10mg 地塞米松.记录注射试验药品即刻(T1)、麻醉诱导前(T2)、气管插管后(T3)、气腹开始时(T4)、术毕(T5)的平均动脉压、心率,比较三组不同时点血流动力学指标、视觉模拟评分,并记录不良反应以及40项恢复质量评分量表评分.结果 术后48h,高剂量组、低剂量组术后恶心呕吐(PONV)发生率均低于对照组(P<0.05),高剂量组与低剂量组 PONV 发生率比较差异无统计学意义(P>0.05).与对照组比较,高剂量组、低剂量组术后疼痛评分曲线下面积均较低(P<0.05).高剂量组血糖升高发生率高于低剂量组及对照组(P<0.05).T1～T5 时,三组平均动脉压、心率比较差异均无统计学意义(P>0.05).结论 相较于5 mg,10 mg地塞米松对腹腔镜手术后镇痛、止吐及促进恢复质量方面效果相当,但10mg 地塞米松可能会增加血糖升高风险.
Objective To investigate the value of different doses of dexamethasone in the quality of recovery after laparoscopic cholecystectomy and appendectomy.Methods A total of 123 patients,aged≥18 years,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,who were scheduled to undergo laparoscopic cholecystectomy or appendectomy in Tianjin First Hospital from July 2022 to July 2024 were enrolled.According to a random number table method,the patients were divided into three groups,the control group(n=41),the low-dose group(n=41),and the high-dose group(n=41).All three groups received general anesthesia.The control group received an equal volume of normal saline before anesthesia induction,the low-dose group received 5 mg of dexamethasone,and the high-dose group received 10 mg of dexamethasone.Mean arterial pressure and heart rate were recorded immediately after injection of the investigational drug(T1),before anesthesia induction(T2),after tracheal intubation(T3),at the start of pneumoperitoneum(T4),and at the end of surgery(T5).Hemodynamic parameters,visual analogue scale scores at different time points,adverse reactions,and the 40-item quality of recovery score were compared among the three groups.Results At 48 h after surgery,the incidence of postoperative nausea and vomiting(PONV)in the high-dose and low-dose groups was lower than that in the control group(P＜0.05),but there was no significant difference between the high-dose and low-dose groups(P＞0.05).Compared with the control group,the area under the pain score curve was lower in both the high-dose and low-dose groups(P＜0.05).The incidence of hyperglycemia was higher in the high-dose group than that in the low-dose and the control group(P＜0.05).At T1-T5,there were no statistically significant differences in mean arterial pressure or heart rate among the three groups(P＞0.05).Conclusion Compared with 5 mg of dexamethasone,10 mg of dexamethasone provides similar effects on postoperative analgesia,antiemesis,and quality of recovery after laparoscopic resection,but 10 mg of dexamethasone may increase the risk of hyperglycemia.
董浩;彭丽媛;王振山
天津市第一医院麻醉科,天津 300192天津医科大学朱宪彝纪念医院痛风科,天津 300192天津市第一医院麻醉科,天津 300192
腹腔镜手术地塞米松恶心呕吐疼痛恢复质量
laparoscopic surgerydexamethasonenausea and vomitingpainrecovery quality
《麻醉安全与质控》 2026 (4)
324-329,6
天津市医学重点学科(专科)建设项目资助(TJYXZDXK-032A)
评论