Department of Anesthesia, Huashan Hospital, Fudan University, Shanghai, China.
Minerva Anestesiol. 2013 Feb;79(2):130-6. Epub 2012 Nov 8.
Combined dexamethasone and tropisetron have been reported more effective than a single drug therapy in preventing postoperative nausea and vomiting (PONV). However, the safety use of dexamethasone has been questioned recently because of the risk of secondary adrenal deficiency. Therefore, we hypothesized that combined tropisetron and methylprednisolone, a short-lasting corticoid, might provide effective prophylaxis of PONV with less effect on endogenous cortisol level.
In this study, 224 women undergoing modified radical mastectomy under general anesthesia were randomly divided into three groups: 1) receiving 10 mg tropisetron alone (T, N.=76); 2) 10 mg tropisetron and 8 mg dexamethasone (TD, N.=73); or 3) 10 mg tropisetron and 40 mg methylprednisolone (TM, N.=75) intravenously. Serum cortisol level, episodes of PONV and the need for rescue antiemetic medication were recorded during first 3 days after surgery.
Serum cortisol significantly decreased in group TD (5.42±1.87 μg/dL), compared with group TM (14.38±2.01 μg/dL, P<0.01) and group T (19.52±1.53 μg/dL, P<0.001) in the first day postoperatively. In the first 24 hours, the incidence of vomiting was significantly higher in group T (15.8%), compared with group TD (5.5%, P<0.05) and group TM (5.3%, P<0.05), respectively. The overall request for a rescue antiemetic of group T was significantly higher, compared with group TD and group TM (P<0.05).
Methylprednisolone-tropisetron combination is more effective than tropisetron alone, and as equally effective as dexamethasone-tropisetron combination for preventing acute PONV in mastectomy.
联合地塞米松和托烷司琼已被报道比单一药物治疗更能有效预防术后恶心和呕吐（PONV）。然而，由于内源性皮质醇水平的风险，地塞米松的安全使用最近受到了质疑。因此，我们假设联合托烷司琼和甲泼尼龙，一种短效皮质类固醇，可能会提供有效的 PONV 预防作用，对内源性皮质醇水平的影响较小。
在这项研究中，224 名接受全身麻醉下改良根治性乳房切除术的女性患者被随机分为三组：1）单独接受 10mg 托烷司琼（T 组，N=76）；2）10mg 托烷司琼和 8mg 地塞米松（TD 组，N=73）；或 3）10mg 托烷司琼和 40mg 甲泼尼龙（TM 组，N=75）静脉注射。记录术后第 1 天至第 3 天的血清皮质醇水平、PONV 发作次数和需要抢救性止吐药物的情况。
与 TM 组（14.38±2.01μg/dL，P<0.01）和 T 组（19.52±1.53μg/dL，P<0.001）相比，TD 组（5.42±1.87μg/dL）的血清皮质醇水平在术后第 1 天显著下降。在最初的 24 小时内，T 组（15.8%）的呕吐发生率明显高于 TD 组（5.5%，P<0.05）和 TM 组（5.3%，P<0.05）。与 TD 组和 TM 组相比，T 组对抢救性止吐药物的总体需求明显更高（P<0.05）。
甲泼尼龙-托烷司琼联合用药比单独使用托烷司琼更有效，与地塞米松-托烷司琼联合用药预防乳房切除术急性 PONV 的效果相同。
