术前单次应用氟美松对结直肠癌患者腹腔镜术后恶心、呕吐、疼痛的影响  

Effect of single preoperative application of dexamethasone on the nausea,vomiting and pain after laparoscopic colorectal resection

作　　者：王玉全 刘敬[3] 赵武杰[4] 赵召龙 谷斌[2] 段志辉[2] 杨伟光 冯博 郭丽改 李中信[2] 

机构地区：[1]河北省深州市医院外科,053800 [2]河北医科大学第四医院外二科,石家庄050011 [3]河北省衡水市桃城区妇幼保健院,053000 [4]河北省人民医院肿瘤三科,石家庄050051 [5]河北省石家庄平安医院病理科,050021

出　　处：《中华结直肠疾病电子杂志》2015年第5期44-49,共6页Chinese Journal of Colorectal Diseases(Electronic Edition)

基　　金：河北省科技厅支撑计划(12276104D-78)

摘　　要：目的观察术前单次应用糖皮质激素对结直肠癌术后恶心、呕吐、疼痛及应激的影响。方法选取2013年11月至2014年4月间在河北医科大学第四医院外二科接受手术治疗的60例结直肠癌患者。患者随机分成两组:对照组:腹腔镜手术联合加速康复外科;实验组:在腹腔镜手术联合加速康复外科的基础上,术前单次应用氟美松5 mg静注。分别于术后0-2 h、2-24 h、24-48 h进行恶心、呕吐及疼痛评分,测定术前1天及术后1-3天的C反应蛋白(CRP)及外周血氢化可的松水平。结果与对照组相比,术前应用氟美松可以明显缓解术后0-2h、2-24h的恶心、呕吐(P<0.05);对照组和实验组术后0-2h疼痛评分分别为2.33±0.49 vs 1.60±0.63(P=0.001),2-24h则为2.27±0.64vs 1.53±0.52(P=0.006),而24-48 h为2.13±0.83 vs 1.47±0.51(P=0.014)。术后1-3d,实验组的CRP和外周血氢化可的松水平均低于对照组(P<0.01)。结论术前单次应用糖皮质激素能缓解结直肠癌术后恶心、呕吐及切口疼痛及应激反应,且安全可行。Objective To investigate the effect of single preoperative application of dexamethasone on the nausea , vomiting and pain after laparoscopic colorectal resection .Methods Sixty colorectal cancer patients were collected during November 2013 to April 2014 in the Second Department of Surgery ,the Fourth Hospital of Hebei Medical University .These patients were randomly divided into two groups .Patients in control group were treated with laparoscopic surgery combined with routine fast track surgery .Patients in treatment group were additionally injected 5 mg dexamethasone intravenously half an hour before surgery .We scored the nausea,vomiting and pain at the time point of 0 to 2 hours,2 to 24 hours,24 to 48 hours after surgery respectively ,and measured the level of serum CRP and dexamethasone one day before and one to three days after surgery .Results Preoperative application of dexamethasone resulted achieved a significant relief of nausea and vomiting 0 to 2 hours and 2 to 24 hours after surgery compared with the control group ( P<0.05).The pain scoring of 2 hours after surgery in the control and treated group was 2.33 ±0.49 vs 1.60 ±0.63(P=0.001),2 to 24 hours 2.27 ±0.64 vs 1.53 ±0.52(P=0.006),24 to 48 hours 2.13 ±0.83 vs 1.47 ±0.51(P=0.014).The level of CRP and serum hydrocortisone 1 to 3 days after surgery was lower in the treated group than the control group ( P <0.01 ).Conclusion Single preoperative application of glucocorticoidcan relieve the nausea ,vomiting and pain after surgery for colorectal cancer patients ,and it is safe and feasible .

关 键 词：结直肠肿瘤 糖皮质激素类 加速康复外科 恶心 呕吐 疼痛 

分 类 号：R735.34[医药卫生—肿瘤]