Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Western Australia.
School of Medicine and Pharmacology, University of Western Australia.
Br J Anaesth. 2017 Aug 1;119(2):221-230. doi: 10.1093/bja/aex154.
Anaesthetists use dexamethasone principally for its anti-emetic effect. The purpose of this study was to characterize the effects of a single intraoperative dose of dexamethasone on cellular and metabolic components of the immune system in patients undergoing laparoscopic surgical procedures.
In this prospective double-blind trial, female patients undergoing elective major laparoscopic surgery were randomized to receive saline (Control group, n =16) or dexamethasone 4 mg (Dexamethasone group, n =16) i.v. after the induction of anaesthesia. Inflammatory markers and immune cell counts were examined at 24 and 48 h and 6 weeks after surgery. The changes from baseline preoperative values were compared between groups using a Mann-Whitney U -test, and linear mixed models were used to validate the findings.
No differences in concentrations of serum glucose and interleukin-6 were observed between groups after surgery. The increase in C-reactive protein concentration at 24 h after surgery was greater in the control group [median (interquartile range), 33 (25-65) vs 17 (7-26) mg dl -1 ; P =0.018]. Extensive changes in the counts of white cells, including most lymphocyte subsets, were observed 24 h after surgery, and dexamethasone appeared to attenuate most of these changes. Changes at 48 h and 6 weeks did not differ between groups.
In female patients undergoing elective laparoscopic gynaecological surgery, dexamethasone administration appears to attenuate inflammation and to alter immune cell counts at 24 h, with no effects identified after this time. The importance of these changes for postoperative immune function is unknown.
Australia and New Zealand Clinical Trials Registry (ACTRN12608000340336).
麻醉师主要将地塞米松用于其止吐作用。本研究的目的是描述单次术中给予地塞米松对接受腹腔镜手术的患者的免疫系统的细胞和代谢成分的影响。
在这项前瞻性双盲试验中，择期行腹腔镜大手术的女性患者在麻醉诱导后接受生理盐水（对照组，n = 16）或地塞米松 4 mg（地塞米松组，n = 16）静脉注射。在手术后 24 和 48 小时和 6 周时检查炎症标志物和免疫细胞计数。使用 Mann-Whitney U 检验比较组间基线术前值的变化，并使用线性混合模型验证结果。
手术后两组之间血清葡萄糖和白细胞介素-6的浓度无差异。手术后 24 小时 C 反应蛋白浓度的增加在对照组中更大[中位数（四分位距），33（25-65）比 17（7-26）mg dl -1 ；P = 0.018]。手术后 24 小时观察到白细胞计数的广泛变化，包括大多数淋巴细胞亚群，地塞米松似乎减轻了大多数这些变化。48 小时和 6 周时的变化在两组之间没有差异。
在择期行腹腔镜妇科手术的女性患者中，地塞米松给药似乎可在 24 小时减轻炎症并改变免疫细胞计数，但在此时间后未发现其他影响。这些变化对术后免疫功能的重要性尚不清楚。
澳大利亚和新西兰临床试验注册（ACTRN12608000340336）。
