地塞米松減輕術(shù)后惡心嘔吐Dexamethasone reduces the severity of postoperativ

1、Dexamethasone reduces the severity of postoperative sore throat地塞米松減輕術(shù)后惡心嘔吐Purpose: Dexamethasone may have potential advantages in the prevention of postoperative sore throat. We therefore Undertook a study to evaluate the efficacy of intravenously administered dexamethasone in reducing the incidenc

2、e and severity of postoperative sore throat in patients receiving generalanesthesia with endotracheal intubation.目的：地塞米松可能在預防術(shù)后惡心嘔吐方面具有潛在優(yōu)勢。因此我們做了一項研究，評估靜脈用地塞米松在減輕氣管插管全麻術(shù)后惡心嘔吐發(fā)生率和嚴重程度的有效性。Methods: In a randomized, double-blind and placebo-controlled study, 120 patients receiving general anesthesia w

3、ith endotracheal intubation were randomly assigned to two groups.Group 1 (control) patients received normal saline 2 mL iv and group 2 (D) patients received dexamethasone 8 mg iv. Aftersurgery, visual analogue scale (VAS) scores at rest and with effort (swallowing movement) for postoperative sore th

4、roat were recorded by a blinded observer.方法：在一項隨機、雙盲、安慰劑對照實驗中，120名接受氣管內(nèi)插管全麻的患者被隨機分為兩組。組1（對照組）病人靜脈注射生理鹽水2ml；組2（實驗組）病人靜脈注射地塞米松8ml。術(shù)后，用視覺模擬評分表（VAS）評分評估術(shù)后病人安靜時和用力時（吞咽）惡心嘔吐程度，評估人員不知道分組情況。Results: The overall incidence of postoperative sore throat during the first 24 hr following surgery was lower in dexa

5、methasone group (D) compared to the control group (C). Eleven (20%) patients in the dexamethasone group had postoperative sore throat, compared to 31 (56.3%) patients in the controlgroup (P < 0.01). Postoperatively at one hour, three hours, six hours, 12 hr and 24 hr, the VAS scores for postopera

6、tive sore throat at rest and during effort were lower in the dexamethasone group (D) compared to the control group (P < 0.01) at corresponding time intervals.結(jié)果：術(shù)后24h內(nèi)，地塞米松組（D組）比安慰劑組（C組）惡心嘔吐發(fā)生率降低。在地塞米松組有11個（20%）病人發(fā)生術(shù)后惡心嘔吐，安慰劑組有31個（56.3%）病人發(fā)生惡心嘔吐（P<0.01）。在術(shù)后1h、3h、6h、12h、和24h，地塞米松組（D組）病人安靜或用力時惡心

7、嘔吐的發(fā)生率都較安慰組要低（P<0.01)。Conclusion: Preoperative administration of dexamethasone 8mg iv reduces the incidence and severity of postoperative sore throat in patients receiving general anesthesia with endotracheal intubation.結(jié)論：術(shù)后靜脈注射8mg地塞米松可有效降低氣管插管全麻病人惡心嘔吐發(fā)生率。POSTOPERATIVE sore throat is a common co

8、mplaint in patients receiving general anesthesia with endotracheal intubation.The reported incidence of postoperative sorethroat is up to 90%.1 Sore throat is often the predominant postoperative complaint when surgical pain iswell controlled, particularly by local/regional analgesia.Factors contribu

9、ting to the development of sore throat include trauma to pharyngolaryngeal mucosa from laryngoscopy, placement of a nasogastric tube,or oral suctioning,2 cuff design, pressure affecting tracheal mucosal capillary perfusions ,4 and contact of the tracheal tube with the vocal cords and posterior phary

10、ngeal wall resulting in edema or mucosal lesions.5 The common measures for the prevention of postoperative sore throat include the use of endotracheal tubes with a low intracuff pressure,4,6 smaller-sized endotracheal tubes,5 topical lidocaine,7 steroid coated endotracheal tubes,8 and inhalation of

11、steroids.9術(shù)后惡心嘔吐是氣管內(nèi)插管全麻病人常見的并發(fā)癥，報道稱術(shù)后惡心嘔吐發(fā)生率達90%?！?】當手術(shù)引起的疼痛被良好控制時，惡心嘔吐常成為術(shù)后最常見的并發(fā)癥，特別是局部/區(qū)域鎮(zhèn)痛時。引起惡心嘔吐的因素包括：咽喉部黏膜損傷，鼻胃管的放置或者經(jīng)口吸引，【2】氣囊設(shè)計及其壓力造成的氣管黏膜毛細血管充血，【4】氣管導管接觸聲帶和咽喉壁引起的水腫或黏膜損傷?！?】常用的避免術(shù)后惡心嘔吐的方法有：降低氣管內(nèi)導管氣囊壓力，【4、6】用小一號的氣管插管，【5】局部利多卡因涂抹，【7】氣管插管表面涂抹激素，【8】和激素吸入法?！?】Dexamethasone is a potent corticos

12、teroid with analgesic, anti-inflammatory and antiemetic action.1012 Preoperative dexamethasone has been reported to reduce the incidence of postoperative pain and swelling following oral surgeries.1012 A previous study undertaken to evaluate the effect of dexamethasone on postoperative sore throat a

13、fter endotracheal intubation did not address the numerous confounding factors responsible for sore throat.13 With this background knowledge, a prospective, randomized,double-blind, placebo-controlled study was undertaken to test whether a reduction in the incidence and severity of postoperative sore

14、 throat could be achieved by preoperative administration of intravenous dexamethasone in patients receiving general anesthesia with endotracheal intubation.地塞米松是一種具有強效鎮(zhèn)痛、抗炎和抗過敏作用的類固醇激素。10-12據(jù)報道術(shù)前應(yīng)用地塞米松可以降低口周手術(shù)術(shù)后引起的疼痛和腹脹。10-12先前關(guān)于地塞米松對氣管內(nèi)插管全麻后惡心嘔吐療效的實驗沒能明確說明眾多引起惡心嘔吐復雜因素。13在這種知識背景下，為了驗證氣管內(nèi)插管全麻前靜注地塞米松是

15、否會降低術(shù)后惡心嘔吐的發(fā)生幾率和嚴重性，人們做了一項前瞻性的隨機雙盲安慰對照實驗。MethodsAfter approval from local Ethics Committee and obtaining written informed consent, 120 patients of either sex requiring general anesthesia with endotracheal intubation for abdominal and lower limb surgeries, estimated to last one to three hours were en

16、rolledin this prospective, randomized, double-blinded, placebo- controlled study. Included were patients of ASA class I and II, between 20-60 yr of age and weighing between 4075 kg. Patients with a history of recent respiratory tract infection, risk factors for postoperative aspiration, cardiac, res

17、piratory, hepatic or major renal diseases, obesity, diabetes mellitus, pregnancy, prior treatment with analgesics, use of corticosteroidsand calcium channel blockers, and those with neuromuscular diseases were excluded. Finally, any contraindication to corticosteroid medications or failure of the pa

18、tient to understand the study procedure resulted in exclusion.方法經(jīng)當?shù)貍惱砦瘑T會批準并同意撰寫后，120例滿足條件的患者被納入了這項前瞻性隨機雙盲對照實驗，所有患者性別不限，都接受了在氣管內(nèi)插管全麻下的腹部及下肢手術(shù)，手術(shù)時長在1-3h內(nèi)。納入標準：ASA I-II級，年齡20-60歲，體重40-75kg，排除標準：近期呼吸系統(tǒng)感染史，存在術(shù)后吸氣或呼氣障礙，心臟病，肝腎等重要器官疾病危險因素的患者，過度肥胖者，糖尿病患者，妊娠婦女，鎮(zhèn)痛藥物治療史患者，應(yīng)用糖皮質(zhì)激素和鈣離子通道阻滯劑患者，患有神經(jīng)系統(tǒng)疾病者。所有對類固醇激素過敏

19、和不能理解實驗過程的患者也被排除在外。The protocol for study and the use of visual analogue scale (VAS) were explained to all patients during their preoperative visit to the hospital. Patient randomization was done with the use of computer-generated codes. Only the pharmacist and the statisticianknew the identity of t

20、he study medication. Procedures were in place to break the codes in the event of any adverse reaction. Patients were to receive one of the two assigned study medications: group 1 (control) patients received normal saline 2 mL iv, group 2 (D)patients received dexamethasone 8 mg iv (Decdan; 4mg·m

21、L1; Merind, Mumbai, India).在術(shù)前訪視時，向所有患者解釋實驗步驟和視覺模擬評分表（VAS）的使用。將所有患者用隨機數(shù)表分組。只有藥劑師和統(tǒng)計人員知道那組是實驗藥物組。所有步驟均按計劃進行以避免任何不良反應(yīng)的發(fā)生。病人將接受實驗設(shè)計里兩種藥物中的一種：組1（C）病人靜注生理鹽水2ml，組2（D）病人靜注地塞米松8mg。On the day of surgery patients were premedicated with alprazolam 0.5 mg, po preoperatively. In the operating room routine monito

22、rs were applied electrocardiogram), non-invasive blood pressure monitor and pulse oximeter (SpO2). Patients were randomly allocated to receive an injection of either dexamethasone 8 mg iv or an equivalent volume of normal saline.手術(shù)當天，每個病人術(shù)前靜注阿普唑侖0.5mg，手術(shù)室常規(guī)檢測【心電圖，無創(chuàng)血壓和血氧飽和度（SpO2）】。病人隨機分組，靜脈注射8mg地塞米松

23、或者等量的生理鹽水。Prior to induction of anesthesia a lumbar epidural catheter was placed and tested. Bupivacaine 0.25% was administered intraoperatively and postoperatively into the epidural catheter by continuous infusion at rates between 68 mL·hr1. Anesthesia was induced withpropofol 2 mg·kg1 iv

24、 and morphine 0.1 mg·kg1 iv, with orotracheal intubation facilitated by vecuronium0.1 mg·kg1 iv. Endotracheal tubes (ETT) with a lowpressure cuff (Portex; Portex Limited, UK) were used.Laryngoscopy was performed by the same anesthesiologistin both groups using standard 3 or 4 Macintosh met

25、al blades. 麻醉前，硬膜外放置導管并測試其通暢性，術(shù)中和術(shù)后持續(xù)硬膜外泵注0.25%的布比卡因6-8ml/hr。麻醉誘導靜注丙泊酚2mg/kg，嗎啡0.1mg/kg,Male patients received either an 8 or 8.5mm internal diameter (ID) ETT and female patients received either a 7 or 7.5-mm ID ETT. Application of external laryngeal pressure to aid endotracheal intubation was recor

26、ded. The cuff was inflated just to the point of obtaining a seal in the presence of positive airway pressure. Intracuff pressure was adjusted every 30 min as required using a pressure gauge to limit nitrous oxide-related intracuff pressure increase. Oral or nasal airways were not placed in any patient, coughing or bucking on the ETT, if any, were recorded. The lungs were mechanically ventilated with N2O:O2 (1:1) and isoflurane (0.71% end-tidal c