Pang Qian-Yun, Wang Jing-Yun, Liang Xiao-Long, Jiang Yan, Liu Hong-Liang
Department of Anesthesiology, Chongqing University Cancer Hospital, No. 181, Hanyu Road, Shapingba District, Chongqing City, 400030, China.
School of Medicine, Chongqing University; Chongqing University Cancer Hospital, Chongqing, 400030, China.
Perioper Med (Lond). 2023 Mar 8;12(1):4. doi: 10.1186/s13741-023-00293-4.
Dexamethasone is commonly used for antiemesis in surgical patients. It has been confirmed that long-term steroid use increases blood glucose level in both diabetic and non-diabetic patients, it is unclear how a single dose of intravenous dexamethasone used pre/intraoperatively for postoperative nausea and vomiting (PONV) prophylaxis would influence the blood glucose and wound healing in diabetic patients.
The Pubmed, Cochrane Library, Embase, Web of Science databases, CNKI and Google Scholar were searched. The articles reporting a single dose dexamethasone administered intravenously for antiemesis in surgical patients with diabetes mellitus (DM) were included.
Nine randomized controlled trials (RCTs) and 7 cohort studies were included in our meta-analysis. The results showed that dexamethasone increased glucose level intraoperatively (MD: 0.439, 95% CI: 0.137-0.581, I = 55.7%, P = 0.004), at the end of surgery (MD: 0.815, 95% CI: 0.563-1.067, I = 73.5%, P = 0.000), on postoperative day (POD) 1 (MD: 1.087, 95% CI: 0.534-1.640, I = 88%, P = 0.000), on POD 2 (MD: 0.501, 95% CI: 0.301-0.701, I = 0%, P = 0.000), and increased peak glucose level within 24 hours of surgery (MD: 2.014, 95% CI: 0.503-3.525, I = 91.6%, P = 0.009) compared with control. It indicated that dexamethasone caused the increase of perioperative glucose level at different time points by 0.439 to 1.087 mmol/L (7.902 to 19.566 mg/dL), and the increase of peak glucose level within 24 hours of surgery by 2.014 mmol/L (36.252 mg/dL) compared with control. Dexmethasone had no impact on wound infection (OR: 0.797, 95%CI: 0.578-1.099, I = 0%, P = 0.166) and healing (P < 0.05).
Dexamethasone could increase blood glucose by only 2.014 mmol/L (36.252 mg/dL) of peak glucose level within 24 hours of surgery in surgery patients with DM, the increase of glucose level at each time point perioperatively was even lower, and had no effect on wound healing. Thus, dexamethasone with a single dose could be safely used for PONV prophylaxis in diabetic patients.
The protocol of this systematic review was registered in INPLASY with the registration number INPLASY202270002.
地塞米松常用于手术患者的止吐。已证实长期使用类固醇会使糖尿病患者和非糖尿病患者的血糖水平升高，目前尚不清楚术中/术前单次静脉注射地塞米松用于预防术后恶心呕吐（PONV）会如何影响糖尿病患者的血糖和伤口愈合。
检索了PubMed、Cochrane图书馆、Embase、Web of Science数据库、中国知网和谷歌学术。纳入了报道对糖尿病（DM）手术患者静脉注射单次剂量地塞米松用于止吐的文章。
我们的荟萃分析纳入了9项随机对照试验（RCT）和7项队列研究。结果显示，与对照组相比，地塞米松使术中血糖水平升高（MD：0.439，95%CI：0.137 - 0.581，I = 55.7%，P = 0.004），手术结束时血糖水平升高（MD：0.815，95%CI：0.563 - 1.067，I = 73.5%，P = 0.000），术后第1天（POD 1）血糖水平升高（MD：1.087，95%CI：0.534 - 1.640，I = 88%，P = 0.000），术后第2天（POD 2）血糖水平升高（MD：0.501，95%CI：0.301 - 0.701，I = 0%，P = 0.000），并使手术24小时内的血糖峰值水平升高（MD：2.014，95%CI：0.503 - 3.525，I = 91.6%，P = 0.009）。这表明与对照组相比，地塞米松使围手术期不同时间点的血糖水平升高0.439至1.087 mmol/L（7.902至19.566 mg/dL）, 并使手术24小时内的血糖峰值水平升高2.014 mmol/L（36.252 mg/dL）。地塞米松对伤口感染（OR：0.797，95%CI：0.578 - 1.099，I = 0%，P = 0.166）和愈合无影响（P < 0.05）。
地塞米松在DM手术患者中仅使手术24小时内的血糖峰值水平升高2.014 mmol/L（36.252 mg/dL），围手术期各时间点的血糖升高幅度更低，且对伤口愈合无影响。因此，单次剂量的地塞米松可安全用于糖尿病患者的PONV预防。
本系统评价方案已在INPLASY注册，注册号为INPLASY202270002。
