Lorenzetti M E, Roberts-Thomson I C, Pannall P R, Taylor W B
Department of Gastroenterology, Queen Elizabeth Hospital, Australia.
Clin J Pain. 1991 Dec;7(4):318-22. doi: 10.1097/00002508-199112000-00011.
Activation of the sympathetic nervous system appears to be relevant in some patients with unexplained pain after cholecystectomy, particularly those who show increases in plasma transaminase activity after challenge with morphine (morphine responders). In this study, the hypothesis that dexamethasone would improve chronic biliary pain, perhaps by suppressing activation of the sympathetic nervous system, was tested in a double-blind, placebo-controlled, cross-over trial in 20 patients, 10 morphine responders and 10 nonresponders. Before treatment with dexamethasone and placebo, urinary excretion of norepinephrine (NE) was significantly higher (p less than 0.05) in morphine responders than in nonresponders. During treatment with dexamethasone, 1 mg each night for 4 weeks, neither morphine responders nor nonresponders showed a significant improvement in pain or nausea or a significant reduction in sympathoadrenomedullary activity as assessed by urinary excretion of catecholamines. At the dose administered, dexamethasone was unhelpful for chronic pain after cholecystectomy and did not result in suppression of the sympathetic nervous system as assessed by urinary excretion of NE.
交感神经系统的激活在一些胆囊切除术后出现不明原因疼痛的患者中似乎具有相关性，尤其是那些在注射吗啡后血浆转氨酶活性升高的患者（吗啡反应者）。在本研究中，地塞米松或许通过抑制交感神经系统的激活来改善慢性胆源性疼痛这一假设，在一项双盲、安慰剂对照、交叉试验中对20例患者进行了测试，其中10例为吗啡反应者，10例为无反应者。在用地塞米松和安慰剂治疗前，吗啡反应者的去甲肾上腺素（NE）尿排泄量显著高于无反应者（p<0.05）。在每晚服用1 mg地塞米松、持续4周的治疗期间，无论是吗啡反应者还是无反应者，其疼痛或恶心均未显著改善，通过儿茶酚胺尿排泄量评估的交感肾上腺髓质活性也未显著降低。在所给予的剂量下，地塞米松对胆囊切除术后的慢性疼痛并无帮助，且通过NE尿排泄量评估未导致交感神经系统受到抑制。
