【摘要】 目的探讨小剂量地塞米松干预腹腔镜胆囊切除术(LC)术后胃肠道反应(恶心呕吐)的效果,寻求地塞米松的最小有效干预剂量。方法选择200例病人,随机分为5组(n=40)。分别于麻醉诱导前静注地塞米松0.05 mg.kg-1(D0.05组)、地塞米松0.1 mg.kg-1(D0.1组)、地塞米松0.2 mg.kg-1(D0.2组)、恩丹西酮4 mg(O组)和同量生理盐水(S组)。分别观察记录手术后0~24 h内病人PONV情况、抗恶心呕吐药物使用情况。结果 D0.1组、D0.2组与S组比较:术后0~24小时内总的PONV的发生率明显降低(P<0.01),总需要抗胃肠反应药物治疗的病人比例亦降低(P<0.05)。D0.1组与D0.2组比较没有统计学差异(P>0.05)。D0.05组S组比较没有统计学差异(P>0.05)。D0.1组与D0.05组比较,术后0~24 h内总的PONV的发生率明显降低(P<0.01),需要减轻恶心、呕吐药物治疗的病人比例亦降低(P<0.05)。D0.1组与0组比较:术后0~24 h内PONV发生率降低(P<0.05)。结论静脉注射地塞米松0.1 mg.kg-1能有效地预防LC后PONV发生,效果与0.2mg.kg-1相当。静脉注射地塞米松0.05 mg.kg-1不能有效预防LC后PONV。提示0.1 mg.kg-1地塞米松是预防LC后PONV的佳有效剂量。更多还原

【Abstract】 Objective: To investigate the efficacy of intravenous of different dosages of dexamethasone in preventing postoperative nausea and vomiting in patients undergoing LC. Methods: 200 cases ASA physical status I and II patients,aged from 18 to 65 years old. The patients were randomly divided into five groups( n = 40 each). Patients receive dexamethasone 0. 05mg. kg-1( D0. 05 group),0. 1mg. kg-1( D0. 1 group),0. 2mg. kg-1( D0. 2 group),ondansetron 4mg( O group),and saline( S group) before the induction of general anesthesia. All patients received a standardized anaesthetic and surgical treatment. the episodes of nausea and vomiting and antiemetic requirements were recorded during 0 ~ 24 h respectively after the operation. Results : Groups D0. 1 and D0. 2 were significantly different from Group S during 0 ~ 24h after operation in the incidences of PONV( respectively P < 0. 01),and the patients requiring rescue antiemetics( P < 0. 05, respectively). The PONV and the proportions of patients requiring rescue antiemetics between Groups D0. 1 and D0. 2 were not significant( P > 0. 05). The efficacy of Groups D0. 05 for preventing postoperative nausea and vomiting is poor. Groups D0. 05 and S were not significant( P > 0. 05). Groups D0. 1 were significantly different from Group D0. 05 during 0-24h after operation in the incidences of PONV( P < 0. 01),and the proportions of patients requiring rescue antiemetics( P < 0. 05). Conclusions: Dexamethasone 0. 1mg. kg-1was as effective as dexamethasone 0. 2 mg. kg-1and was more effective than saline control for preventing PONV in patients undergoing laparoscopic cholecystectomy. Dexamethasone 0. 05mg. kg-1 was in effective for this purpose. Dexamethasone 0. 1mg. kg-1is suggested to be the minimum effective dose in this patient population.更多还原