Wei Julie L, Kasperbauer Jan L, Weaver Amy L, Boggust Andrew J
Department of Otorhinolaryngology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, U.S.A.
Laryngoscope. 2002 Jan;112(1):87-93. doi: 10.1097/00005537-200201000-00016.
Pharyngeal inflammatory pain is reduced by a single dose of dexamethasone.
Prospective, randomized, double-blinded, placebo-controlled study.
From August 1998 to July 2000, a total of 118 patients were enrolled. We compared placebo (n = 37), a 10-mg single dose of intramuscular injection of dexamethasone (n = 39), and a 10-mg single dose of oral dexamethasone (n = 42). All patients were given oral antibiotics and had bacterial throat cultures.
Complete telephone follow-up 12 hours after treatment was available in 111 patients, and 24-hour follow-up data were available in 116. The change in pain visual analogue scale scores (pretreatment score minus 12-h follow-up score) reported by patients who were given either intramuscular (median score, 4; mean score +/- SD, 4.2 +/- 2.3) or oral dexamethasone (median score, 3; mean score +/- SD, 3.8 +/- 2.3) was significantly greater than that of the patients who were given placebo (median score, 2; mean score +/- SD, 2.1 +/- 2.0) (P <.001 and P =.002, respectively). This difference in improvement was also evident when the percentage of change was compared in the three treatment arms at 12-hour and 24-hour follow-up. Patients who were given dexamethasone had the onset of pain relief a median of 4 hours earlier than those who were given oral and intramuscular placebo (P =.029). Statistically significant differences among the three treatment arms were confirmed when a bacterial pathogen was identified (n = 47) but not in a subset that did not have a pathogen identified.
Single-dose dexamethasone appears to be a safe, effective, and inexpensive adjunctive treatment for acute pharyngitis in patients 15 years of age and older. Patients treated with intramuscular or oral dexamethasone had significant relief of pain (relative to baseline) compared with patients who were given placebo. Identification of a bacterial pathogen had a significant impact on the response to dexamethasone.
单次剂量的地塞米松可减轻咽部炎性疼痛。
前瞻性、随机、双盲、安慰剂对照研究。
1998年8月至2000年7月，共纳入118例患者。我们比较了安慰剂组（n = 37）、单次肌肉注射10毫克地塞米松组（n = 39）和单次口服10毫克地塞米松组（n = 42）。所有患者均给予口服抗生素，并进行咽部细菌培养。
111例患者在治疗后12小时完成了电话随访，116例患者有24小时随访数据。接受肌肉注射（中位数评分，4；平均评分±标准差，4.2±2.3）或口服地塞米松（中位数评分，3；平均评分±标准差，3.8±2.3）的患者报告的疼痛视觉模拟量表评分变化（治疗前评分减去12小时随访评分）显著大于接受安慰剂的患者（中位数评分，2；平均评分±标准差，2.1±2.0）（分别为P <.001和P =.002）。在12小时和24小时随访时比较三个治疗组的变化百分比时，这种改善差异也很明显。接受地塞米松治疗的患者疼痛缓解开始时间比接受口服和肌肉注射安慰剂的患者中位数早4小时（P =.029）。当鉴定出细菌病原体时（n = 47），三个治疗组之间存在统计学显著差异，但在未鉴定出病原体的亚组中则无差异。
单次剂量的地塞米松似乎是15岁及以上急性咽炎患者安全、有效且廉价的辅助治疗方法。与接受安慰剂的患者相比，接受肌肉注射或口服地塞米松治疗的患者疼痛（相对于基线）有显著缓解。鉴定出细菌病原体对地塞米松的反应有显著影响。
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