地塞米松在腹腔镜腹部手术中的作用——应激反应炎症标志物综述

The effect of dexamethasone in laparoscopic abdominal surgery - a review on inflammatory markers for stress response.

作者信息

Kaiser Karsten, Karstensen Sven Hoedt, Valorenzos Alexandros Nikolaou Valsamides, Nielsen Kristian Als, Strøm Thomas, Gögenur Ismail, Balsevicius Lukas, Lauszus Finn Friis

机构信息

Department of Gynecology and Obstetrics, Aabenraa Hospital, Sygehus Sønderjylland, Kresten Philipsensvej 15, Aabenraa, Denmark.

Department of Gynecology and Surgery Aabenraa Hospital, Sygehus Sønderjylland, Aabenraa, Denmark.

出版信息

BMC Surg. 2025 Aug 12;25(1):367. doi: 10.1186/s12893-025-03061-x.

DOI:10.1186/s12893-025-03061-x

PMID:40797309

Abstract

BACKGROUND

We aimed to perform a review focused on the effects of dexamethasone on markers of surgical stress in the context of laparoscopic abdominal surgery.

METHODS

This review was registered at PROSPERO. Published reports were evaluated with COVIDENCE, focusing on randomized controlled trials from the MEDLINE, EMBASE and CENTRAL databases. Studies were included if they compared a single intravenous dose of dexamethasone to placebo given preoperatively to adult patients undergoing laparoscopic or robotic assisted abdominal surgery under general anesthesia. The outcome of interest was inflammatory response in general and in particular c-reactive protein.

RESULTS

Out of 588 references, we included seven studies. These involved a variety of surgical procedures, with cholecystectomies being the most common, and included mixed gender populations except in studies on gynecology surgery. Due to the heterogeneity in outcomes and the low number of studies no meta-analysis was performed. Levels of c-reactive protein was 38-60 % lower at 24 to 48 hours postoperatively with a dose of 8 mg dexamethasone compared to placebo, predominantly in cholecystectomy cases. Post-trial calculation indicates that the power of these studies ranged between 60% and 95%.

CONCLUSION

Our review may indicate a reduction of surgical stress in laparoscopic abdominal surgery measured by c-reactive protein, when a single dose of dexamethasone is administered.

TRIAL REGISTRATION

PROSPERO: CRD 42024421062.

摘要

背景

我们旨在进行一项综述，重点关注地塞米松在腹腔镜腹部手术中对外科手术应激标志物的影响。

方法

本综述已在PROSPERO注册。使用COVIDENCE对已发表的报告进行评估，重点关注来自MEDLINE、EMBASE和CENTRAL数据库的随机对照试验。如果研究将单次静脉注射地塞米松与术前给予全身麻醉下接受腹腔镜或机器人辅助腹部手术的成年患者的安慰剂进行比较，则纳入研究。感兴趣的结果是一般炎症反应，特别是C反应蛋白。

结果

在588篇参考文献中，我们纳入了7项研究。这些研究涉及多种外科手术，其中胆囊切除术最为常见，除妇科手术研究外，纳入的研究包括不同性别的人群。由于结果的异质性和研究数量较少，未进行荟萃分析。与安慰剂相比，术后24至48小时，8毫克地塞米松剂量组的C反应蛋白水平降低了38%至60%，主要见于胆囊切除术病例。试验后计算表明，这些研究的检验效能在60%至95%之间。