Sorbonne University, GRC 29, AP-HP, DMU DREAM and Department of Anaesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris, France.
Poly clinique Saint Côme, Service d'anesthésie-réanimation, Compiègne, France.
Anaesth Crit Care Pain Med. 2024 Aug;43(4):101386. doi: 10.1016/j.accpm.2024.101386. Epub 2024 May 6.
Postoperative complications, particularly respiratory complications, are of significant clinical concern in patients undergoing elective thoracic surgery. Dexamethasone (DXM), commonly administered to prevent postoperative nausea and vomiting (PONV), has potential anti-inflammatory effects that might be beneficial in reducing these complications. We aimed to investigate whether intraoperative DXM administration could mitigate the occurrence of respiratory complications following elective thoracic surgery.
We conducted a single-center observational study, including patients who underwent elective thoracic surgery from 2012 to 2020. The primary outcome was the onset of acute respiratory failure within 7 days post-surgery. Secondary outcomes encompassed other postoperative complications, duration of hospital stay, and mortality within 30 days post-surgery. An overlap propensity score analysis was employed to estimate the treatment effect.
We included 1,247 adult patients, 897 who received dexamethasone (DXM) and 350 who served as controls. Intraoperative dexamethasone administration was associated with a significant reduction in respiratory complications with an adjusted relative risk (RR) of 0.65 (95% CI: 0.43-0.97). There was also a significant decline in composite infectious criteria with an adjusted RR of 0.76 (95% CI: 0.63-0.93). Cardiac complications were also assessed as a composite criterion, and a significant reduction was observed (adjusted RR, 0.68; 95% CI, 0.51-0.9). However, there were no association with mechanical complications, mortality within 30 days (adjusted RR of 0.43, 95% CI: 0.17-1.09) or in the length of hospital stay (adjusted RR of 0.85, 95% CI: 0.71-1.02).
Dexamethasone administration was associated with a reduction in postoperative respiratory complications. Further prospective studies are needed to confirm these findings.
术后并发症，尤其是呼吸系统并发症，是择期胸外科手术患者的重要临床关注点。地塞米松（DXM）常用于预防术后恶心和呕吐（PONV），具有潜在的抗炎作用，可能有助于减少这些并发症。我们旨在研究术中给予地塞米松是否可以减轻择期胸外科手术后的呼吸系统并发症。
我们进行了一项单中心观察性研究，纳入了 2012 年至 2020 年期间接受择期胸外科手术的患者。主要结局是术后 7 天内发生急性呼吸衰竭。次要结局包括其他术后并发症、住院时间和术后 30 天内的死亡率。采用重叠倾向评分分析来估计治疗效果。
我们纳入了 1247 例成年患者，其中 897 例接受地塞米松（DXM）治疗，350 例作为对照组。术中给予地塞米松与呼吸系统并发症的显著降低相关，调整后的相对风险（RR）为 0.65（95%可信区间：0.43-0.97）。复合感染标准也显著下降，调整后的 RR 为 0.76（95%可信区间：0.63-0.93）。心脏并发症也被评估为一个复合标准，也观察到显著降低（调整后的 RR，0.68；95%可信区间，0.51-0.9）。然而，与机械并发症、术后 30 天内死亡率（调整后的 RR，0.43，95%可信区间：0.17-1.09）或住院时间（调整后的 RR，0.85，95%可信区间：0.71-1.02）均无关联。
地塞米松给药与术后呼吸系统并发症减少相关。需要进一步的前瞻性研究来证实这些发现。
