Hanasono Matthew M, Lalakea M Lauren, Mikulec Anthony A, Shepard Kimberly G, Wellis Vinit, Messner Anna H
Department of Otolaryngology--Head and Neck Surgery, Stanford University Medical Center, Stanford, CA, USA.
Arch Otolaryngol Head Neck Surg. 2004 Aug;130(8):917-21. doi: 10.1001/archotol.130.8.917.
To determine the effect of preoperative dexamethasone sodium phosphate administration on posttonsillectomy morbidity for electrocautery ("hot") and sharp ("cold") dissection techniques.
Prospective, randomized, double-blind study.
University pediatric hospital and county teaching hospital. Subjects A total of 219 children, aged 9 months to 12 years, undergoing tonsillectomy. Intervention Participants who underwent tonsillectomy were randomly assigned to receive either intravenous dexamethasone sodium phosphate (1 mg/kg) or placebo.
Pain scores, oral intake, and emesis on postoperative day (POD) 1.
A total of 106 subjects (62 undergoing hot and 44 cold tonsillectomies) received preoperative steroids, and 113 (56 hot and 57 cold tonsillectomies) received placebo. On POD 1, pain scores reported by patients (P =.02), parents (P =.002), and physicians (P<.001) were significantly lower in subjects receiving steroids than in those receiving placebo. Emesis was reduced from a mean of 2.1 (placebo group) to 1.2 episodes (steroid group) (P =.02). Oral intake improved from 24.5% of normal diet (placebo) to 31.7% (steroid group) (P =.004). When all 4 groups were compared (cold placebo, cold steroid, hot placebo, and hot steroid), pain scores reported by physicians and parents were significantly lower in the cold steroid group than in the other groups.
Perioperative dexamethasone use reduces posttonsillectomy morbidity in pediatric patients in the early postoperative period after hot or cold tonsillectomy. The combination of steroid and cold dissection technique provided the greatest advantage in reducing posttonsillectomy subjective pain levels.
确定术前给予磷酸地塞米松钠对电灼（“热”）和锐性（“冷”）剥离技术扁桃体切除术后发病率的影响。
前瞻性、随机、双盲研究。
大学儿科医院和县教学医院。
总共219名年龄在9个月至12岁之间接受扁桃体切除术的儿童。
接受扁桃体切除术的参与者被随机分配接受静脉注射磷酸地塞米松钠（1mg/kg）或安慰剂。
术后第1天的疼痛评分、经口摄入量和呕吐情况。
共有106名受试者（62例行热扁桃体切除术和44例行冷扁桃体切除术）接受了术前类固醇治疗，113名（56例行热扁桃体切除术和57例行冷扁桃体切除术）接受了安慰剂治疗。在术后第1天，接受类固醇治疗的受试者的疼痛评分（患者，P = 0.02；家长，P = 0.002；医生，P < 0.001）显著低于接受安慰剂治疗的受试者。呕吐次数从平均2.1次（安慰剂组）减少到1.2次（类固醇组）（P = 0.02）。经口摄入量从正常饮食的24.5%（安慰剂组）提高到31.7%（类固醇组）（P = 0.004）。当比较所有4组（冷安慰剂组、冷类固醇组、热安慰剂组和热类固醇组）时，医生和家长报告的冷类固醇组疼痛评分显著低于其他组。
围手术期使用地塞米松可降低小儿患者热或冷扁桃体切除术后早期的发病率。类固醇与冷剥离技术的联合使用在降低扁桃体切除术后主观疼痛水平方面具有最大优势。
