Fukami Yasuyuki, Terasaki Masaki, Okamoto Yoshichika, Sakaguchi Kenji, Murata Toru, Ohkubo Masayuki, Nishimae Kazumi
Department of Surgery, Shizuoka Saiseikai General Hospital, Shizuoka, 422-8527, Japan.
J Hepatobiliary Pancreat Surg. 2009;16(3):367-71. doi: 10.1007/s00534-009-0079-5. Epub 2009 Mar 31.
BACKGROUND/PURPOSE: Dexamethasone has been reported to reduce postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy (LC). However, its effect on other surgical outcomes such as pain and fatigue have been unclear. The purpose of this clinical study was to evaluate the efficacy of preoperative dexamethasone in ameliorating postoperative symptoms after LC.
In this prospective, double-blind, placebo-controlled study, 80 patients scheduled for LC were analyzed after randomization to intravenous dexamethasone (8 mg) or placebo. All patients underwent standardized procedures for general anesthesia and surgery, and were recommended to remain in hospital for 3 postoperative days. Episodes of PONV, and pain and fatigue scores on a visual analogue scale (VAS) were recorded. Analgesic and antiemetic requirements were also recorded.
There were no apparent side effects of the study drug. Seven patients (18%) in the dexamethasone group reported nausea, compared with 16 (40%) in the placebo group (p = 0.026). One patient (3%) in the dexamethasone group and 7 (18%) in the placebo group reported vomiting (p = 0.025). Dexamethasone significantly reduced the postoperative VAS pain score (p = 0.030) and VAS fatigue score (p = 0.023). The mean number of patients requiring diclofenac sodium 50 mg was 0.9 +/- 1.3 in the dexamethasone group and 2.2 +/- 2.5 in the placebo group (p = 0.002).
The regimen we employed is safe and without apparent side effects. These results suggest that preoperative dexamethasone (8 mg) significantly reduces the incidence of PONV, pain, and fatigue after LC.
背景/目的：据报道，地塞米松可降低腹腔镜胆囊切除术（LC）后的术后恶心呕吐（PONV）发生率。然而，其对疼痛和疲劳等其他手术结局的影响尚不清楚。本临床研究的目的是评估术前使用地塞米松改善LC术后症状的疗效。
在这项前瞻性、双盲、安慰剂对照研究中，80例计划行LC的患者被随机分为静脉注射地塞米松（8 mg）组或安慰剂组后进行分析。所有患者均接受标准化的全身麻醉和手术程序，并建议术后住院3天。记录PONV发作情况以及视觉模拟量表（VAS）上的疼痛和疲劳评分。还记录了镇痛和止吐药物的使用需求。
研究药物无明显副作用。地塞米松组有7例患者（18%）报告恶心，而安慰剂组有16例（40%）（p = 0.026）。地塞米松组有1例患者（3%）报告呕吐，安慰剂组有7例（18%）（p = 0.025）。地塞米松显著降低了术后VAS疼痛评分（p = 0.030）和VAS疲劳评分（p = 0.023）。地塞米松组需要使用50 mg双氯芬酸钠的患者平均人数为0.9±1.3，安慰剂组为2.2±2.5（p = 0.002）。
我们采用的方案安全且无明显副作用。这些结果表明，术前使用地塞米松（8 mg）可显著降低LC术后PONV、疼痛和疲劳的发生率。
