Yamanaga Shigeyoshi, Posselt Andrew Mark, Freise Chris Earl, Kobayashi Takaaki, Tavakol Mehdi, Kang Sang-Mo
Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, USA; Department of General Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Kumamoto, Japan; Department of Renal Transplant Surgery, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan.
Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, USA.
J Transplant. 2017;2017:3518103. doi: 10.1155/2017/3518103. Epub 2017 Jan 22.
A single dose of perioperative dexamethasone (8-10 mg) reportedly decreases postoperative nausea, vomiting, and pain but has not been widely used in laparoscopic donor nephrectomy (LDN). We performed a retrospective cohort study of living donors who underwent LDN between 2013 and 2015. Donors who received a lower dose (4-6 mg) ( = 70) or a higher dose (8-14 mg) of dexamethasone ( = 100) were compared with 111 donors who did not receive dexamethasone (control). Outcomes and incidence of postoperative nausea, vomiting, and pain within 24 h after LDN were compared before and after propensity-score matching. . The higher dose of dexamethasone reduced postoperative nausea and vomiting incidences by 28% ( = 0.010) compared to control, but the lower dose did not. Total opioid use was 29% lower in donors who received the higher dose than in control ( = 0.004). The higher dose was identified as an independent factor for preventing postoperative nausea and vomiting. Postoperative complication rates and hospital stays did not differ between the groups. After propensity-score matching, the results were the same as for the unmatched analysis. A single perioperative injection of 8-14 mg dexamethasone decreases antiemetic and narcotic requirements in the first 24 h, with no increase in surgical complications.
据报道，单剂量围手术期地塞米松（8 - 10毫克）可降低术后恶心、呕吐和疼痛，但尚未在腹腔镜供肾切除术（LDN）中广泛应用。我们对2013年至2015年间接受LDN的活体供者进行了一项回顾性队列研究。将接受较低剂量（4 - 6毫克）（n = 70）或较高剂量（8 - 14毫克）地塞米松（n = 100）的供者与111例未接受地塞米松的供者（对照组）进行比较。在倾向得分匹配前后，比较LDN术后24小时内恶心、呕吐和疼痛的发生率及相关结局。与对照组相比，较高剂量的地塞米松使术后恶心和呕吐发生率降低了28%（P = 0.010），但较低剂量未显示出此效果。接受较高剂量地塞米松的供者总阿片类药物使用量比对照组低29%（P = 0.004）。较高剂量被确定为预防术后恶心和呕吐的独立因素。各组之间术后并发症发生率和住院时间无差异。倾向得分匹配后，结果与未匹配分析相同。围手术期单次注射8 - 14毫克地塞米松可降低术后24小时内的止吐和麻醉需求，且不增加手术并发症。
