Percival V G, Riddell J, Corcoran T B
Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Western Australia, Australia.
Anaesth Intensive Care. 2010 Jul;38(4):661-6. doi: 10.1177/0310057X1003800407.
Dexamethasone is an effective prophylaxis against postoperative nausea and vomiting but is immunosuppressive and may predispose patients to an increased postoperative infection risk. This matched case-control study examined the association between the administration of a single intraoperative anti-emetic dose of dexamethasone (4 to 8 mg) and postoperative infection in patients undergoing non-emergency surgery in a university trauma centre. Cases were defined as patients who developed infection between one day and one month following an operative procedure under general anaesthesia. Controls who did not develop infection were matched for procedure, age and gender Exclusion criteria included immunosuppressive medications, chronic glucocorticoid therapy, cardiac surgical and solid-organ transplantation procedures. Sixty-three cases and 172 controls were identified. Cases were more likely to have received dexamethasone intraoperatively (25.4 vs. 11%, P = 0.006), and less likely to have received perioperative antibiotic prophylaxis (60.3 vs. 84.3%, P = 0.001). Stepwise, multivariate conditional logistic regression confirmed these associations, with adjusted odds ratios of 3.03 (1.06 to 19.3, P = 0.035) and 0.12 (0.02 to 0.7, P = 0.004) respectively for the associations between dexamethasone and perioperative antibiotic prophylaxis, with postoperative infection. We conclude that intraoperative administration of dexamethasone for anti-emetic purposes may confer an increased risk of postoperative infection.
地塞米松是预防术后恶心和呕吐的有效药物，但具有免疫抑制作用，可能使患者术后感染风险增加。这项配对病例对照研究调查了在一所大学创伤中心接受非急诊手术的患者中，术中单次给予抗呕吐剂量的地塞米松（4至8毫克）与术后感染之间的关联。病例定义为在全身麻醉下进行手术操作后1天至1个月内发生感染的患者。未发生感染的对照者在手术、年龄和性别方面进行了匹配。排除标准包括免疫抑制药物、慢性糖皮质激素治疗、心脏手术和实体器官移植手术。共确定了63例病例和172例对照。病例术中更有可能接受地塞米松治疗（25.4%对11%，P = 0.006），而接受围手术期抗生素预防的可能性较小（60.3%对84.3%，P = 0.001）。逐步多变量条件逻辑回归证实了这些关联，地塞米松与围手术期抗生素预防、术后感染之间关联的调整比值比分别为3.03（1.06至19.3，P = 0.035）和0.12（0.02至0.7，P = 0.004）。我们得出结论，术中使用地塞米松用于抗呕吐目的可能会增加术后感染风险。
