Karanicolas Paul J, Smith Shona E, Kanbur Bilge, Davies Edward, Guyatt Gordon H
Department of Surgery, University of Western Ontario, London, Canada.
Ann Surg. 2008 Nov;248(5):751-62. doi: 10.1097/SLA.0b013e3181856024.
To determine the impact of prophylactic corticosteroid administration on postoperative nausea, vomiting, pain and complications in patients undergoing laparoscopic cholecystectomy.
We searched 4 bibliographic databases, conference proceedings, reference lists of articles and textbooks, and contacted experts in the field of anesthesia and hepatobiliary surgery.
We evaluated the methodologic quality of trials and extracted data regarding baseline characteristics, interventions, and outcomes. We pooled results from the studies using a random-effects model, evaluated the degree of heterogeneity, and explored potential explanations for heterogeneity.
Seventeen trials met eligibility criteria and provided high quality evidence regarding steroid effectiveness. Irrespective of the co-interventions (other antiemetic medications), dexamethasone reduced the incidence of nausea (RR 0.59, 95% CI, 0.48-0.72), vomiting (RR 0.41, 95% CI, 0.30-0.55), and postoperative nausea or vomiting (RR 0.55, 95% CI, 0.44-0.67) relative to placebo. Dexamethasone also seemed to reduce the severity of postoperative pain (Ratio of Means 0.87, 95% CI, 0.78-0.98), although substantial unexplained heterogeneity was present (I 90.4%). The incidence of headache and dizziness was similar between groups.
Prophylactic dexamethasone decreases the incidence of nausea and vomiting after LC relative to placebo and may decrease the severity of postoperative pain. Dexamethasone does not increase the incidence of headaches or dizziness. Surgeons should consider administering prophylactic corticosteroids to patients undergoing laparoscopic cholecystectomy, particularly those at high risk of postoperative nausea and vomiting.
确定预防性使用皮质类固醇对接受腹腔镜胆囊切除术患者术后恶心、呕吐、疼痛及并发症的影响。
我们检索了4个文献数据库、会议论文集、文章参考文献列表及教科书，并联系了麻醉和肝胆外科领域的专家。
我们评估了试验的方法学质量，并提取了有关基线特征、干预措施和结局的数据。我们使用随机效应模型汇总研究结果，评估异质性程度，并探讨异质性的潜在原因。
17项试验符合纳入标准，并提供了关于类固醇有效性的高质量证据。无论联合干预措施（其他止吐药物）如何，相对于安慰剂，地塞米松降低了恶心发生率（RR 0.59，95%CI，0.48 - 0.72）、呕吐发生率（RR 0.41，95%CI，0.30 - 0.55）以及术后恶心或呕吐发生率（RR 0.55，95%CI，0.44 - 0.67）。地塞米松似乎也降低了术后疼痛的严重程度（均值比0.87，95%CI，0.78 - 0.98），尽管存在大量无法解释的异质性（I² 90.4%）。两组之间头痛和头晕的发生率相似。
相对于安慰剂，预防性使用地塞米松可降低腹腔镜胆囊切除术后恶心和呕吐的发生率，并可能降低术后疼痛的严重程度。地塞米松不会增加头痛或头晕的发生率。外科医生应考虑对接受腹腔镜胆囊切除术的患者，尤其是术后恶心和呕吐高风险患者，预防性使用皮质类固醇。
