地塞米松减轻术后恶心呕吐Dexamethasone reduces the severity of postoperativ

Dexamethasone reduces the severity of postoperative sore throat地塞米松减轻术后恶心呕吐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 incidence and severity of postoperative sore throat in patients receiving general anesthesia with endotracheal intubation.目的：地塞米松可能在预防术后恶心呕吐方面具有潜在优势。

因此我们做了一项研究，评估静脉用地塞米松在减轻气管插管全麻术后恶心呕吐发生率和严重程度的有效性。

Methods: In a randomized, double-blind and placebo-controlled study, 120 patients receiving general anesthesia with 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. After surgery, visual analogue scale (VAS) scores at rest and with effort (swallowing movement) for postoperative sore throat were recorded by a blinded observer.方法：在一项随机、双盲、安慰剂对照实验中，120名接受气管内插管全麻的患者被随机分为两组。

组1（对照组）病人静脉注射生理盐水2ml；组2（实验组）病人静脉注射地塞米松8ml。

术后，用视觉模拟评分表（VAS）评分评估术后病人安静时和用力时（吞咽）恶心呕吐程度，评估人员不知道分组情况。

Results: The overall incidence of postoperative sore throat during the first 24 hr following surgery was lower in dexamethasone 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 control group (P < 0.01). Postoperatively at one hour, three hours, six hours, 12 hr and 24 hr, the VAS scores for postoperative 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.结果：术后24h内，地塞米松组（D组）比安慰剂组（C组）恶心呕吐发生率降低。

在地塞米松组有11个（20%）病人发生术后恶心呕吐，安慰剂组有31个（56.3%）病人发生恶心呕吐（P<0.01）。

在术后1h、3h、6h、12h、和24h，地塞米松组（D组）病人安静或用力时恶心呕吐的发生率都较安慰组要低（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. 结论：术后静脉注射8mg地塞米松可有效降低气管插管全麻病人恶心呕吐发生率。

POSTOPERATIVE sore throat is a common complaint 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 is well controlled, particularly by local/regional analgesia.Factors contributing 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 pharyngeal wall resulting in edema or mucosal lesions.5 The common measures for the prevention of postoperative sore throat include the use of endotrachealtubes with a low intracuff pressure,4,6 smaller-sized endotracheal tubes,5 topical lidocaine,7 steroid coated endotracheal tubes,8 and inhalation of steroids.9术后恶心呕吐是气管内插管全麻病人常见的并发症，报道称术后恶心呕吐发生率达90%。

【1】当手术引起的疼痛被良好控制时，恶心呕吐常成为术后最常见的并发症，特别是局部/区域镇痛时。

引起恶心呕吐的因素包括：咽喉部黏膜损伤，鼻胃管的放置或者经口吸引，【2】气囊设计及其压力造成的气管黏膜毛细血管充血，【4】气管导管接触声带和咽喉壁引起的水肿或黏膜损伤。

【5】常用的避免术后恶心呕吐的方法有：降低气管内导管气囊压力，【4、6】用小一号的气管插管，【5】局部利多卡因涂抹，【7】气管插管表面涂抹激素，【8】和激素吸入法。

【9】Dexamethasone is a potent corticosteroid with analgesic, anti-inflammatory and antiemetic action.10–12 Preoperative d examethasone has been reported to reduce the incid ence of postoperative pain and swelling foll owing oral surgeries.10–12 A previous study und ertaken to evaluate the effect of d examethasone on postoperative sore throat after end otracheal intubation did not ad dress the numerous confounding factors responsibl e for sore throat.13 With this background knowl edge, a prospective, rand omized,d ouble-blind, placebo-controll ed study was und ertaken to test whether a reduction in the incid ence and severity of postoperative sore throat coul d be achieved by preoperative administration of intravenous d examethasone in patients receiving general anesthesia with end otracheal intubation.地塞米松是一种具有强效镇痛、抗炎和抗过敏作用的类固醇激素。

10-12据报道术前应用地塞米松可以降低口周手术术后引起的疼痛和腹胀。

10-12先前关于地塞米松对气管内插管全麻后恶心呕吐疗效的实验没能明确说明众多引起恶心呕吐复杂因素。

13在这种知识背景下，为了验证气管内插管全麻前静注地塞米松是否会降低术后恶心呕吐的发生几率和严重性，人们做了一项前瞻性的随机双盲安慰对照实验。

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 enrolled in 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 40–75 kg. Patients with a history of recent respiratory tract infection, risk factors for postoperative aspiration, cardiac, respiratory, hepatic or major renal diseases, obesity, diabetes mellitus, pregnancy, prior treatment with analgesics, use of corticosteroids and calcium channel blockers, and those with neuromuscular diseases were excluded. Finally, any contraindication to corticosteroid medications or failure of the patient to understand the study procedure resulted in exclusion.方法经当地伦理委员会批准并同意撰写后，120例满足条件的患者被纳入了这项前瞻性随机双盲对照实验，所有患者性别不限，都接受了在气管内插管全麻下的腹部及下肢手术，手术时长在1-3h内。