切换至 "中华医学电子期刊资源库"
高级检索
中华结直肠疾病电子杂志

中华结直肠疾病电子杂志 ›› 2015, Vol. 04 ›› Issue (05) : 499 -504. doi: 10.3877/cma.j.issn.2095-3224.2015.05.11

所属专题： 文献；

论著

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
王玉全1, 刘敬2, 赵武杰3, 赵召龙4, 谷斌4, 段志辉4, 杨伟光4, 冯博3, 郭丽改5, 李中信4,†()   
  1. 1. 053800　河北省深州市医院外科；050011　石家庄，河北医科大学第四医院外二科
    2. 053000　河北省衡水市桃城区妇幼保健院
    3. 050051　石家庄，河北省人民医院肿瘤三科
    4. 050011　石家庄，河北医科大学第四医院外二科
    5. 050021　河北省石家庄平安医院病理科
  • 收稿日期:2015-06-30 出版日期:2015-10-25
  • 通信作者: 李中信
  • 基金资助:
    河北省科技厅支撑计划(12276104D-78)

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

Yu-quan WANG1, Jing LIU2, Wu-jie ZHAO3, Zhao-long ZHAO4, Bin GU4, Zhi-hui DUAN4, Wei-guang YANG4, Bo FENG3, Li-gai GUO5, Zhong-xin LI4,†()   

  1. 1. Department of Surgery, Shenzhou Hospital, Shenzhou 053800, China, Second Department of Surgery, the Forth Hospital of Hebei Medical University, Shijiazhuang 050011, China
  • Received:2015-06-30 Published:2015-10-25
  • Corresponding author: Zhong-xin LI
  • About author:
    Corresponding author: LI Zhong-xin, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

王玉全, 刘敬, 赵武杰, 赵召龙, 谷斌, 段志辉, 杨伟光, 冯博, 郭丽改, 李中信. 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[J/OL]. 中华结直肠疾病电子杂志, 2015, 04(05): 499-504.

Yu-quan WANG, Jing LIU, Wu-jie ZHAO, Zhao-long ZHAO, Bin GU, Zhi-hui DUAN, Wei-guang YANG, Bo FENG, Li-gai GUO, Zhong-xin LI. Effect of single preoperative application of dexamethasone on the nausea, vomiting and pain after laparoscopic colorectal resection[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2015, 04(05): 499-504.

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±0.64 vs 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。

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
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.

Key words: Colorectal neoplasms, Glucocorticoids, Fast track surgery, Nausea, Vomiting, Pain
表1 两组患者基本资料表
项目 对照组(n＝30) 实验组(n＝30) P值
年龄 63.75±3.34 64.56±3.15 0.497
性别 ? ? 0.301
? 男 16 12 ?
? 女 14 18 ?
体重(Kg) 58.75±6.73 61.86±5.56 0.178
身高(cm) 165.6±7.16 164.5±7.95 0.685
病变部位 ? ? 0.592
? 结肠 10 12 ?
? 直肠 20 18 ?
吸烟史 ? ? 0.390
? 吸烟 7 10 ?
? 不吸烟 23 20 ?
TNM分期 ? ? 0.915
? Ⅰ期 4 3 ?
? Ⅱ期 14 15 ?
? Ⅲ期 12 12 ?
手术时间(h) 4.11±0.37 4.08±0.49 0.833
术中出血(ml) 126.5±20.5 130.0±17.2 0.612
表2 实验组与对照组患者术后恶心呕吐VAS评分的比较表
项目 对照组 实验组 P值
术后0-2 h ? ? 0.014
? 0度 14 25 ?
? I度 10 3 ?
? II度 4 5 ?
? III度 2 0 ?
术后2-24 h ? ? 0.027
? 0度 13 24 ?
? I度 7 3 ?
? II度 5 2 ?
? III度 5 1 ?
术后24-48 h ? ? 0.032
? 0度 16 26 ?
? I度 10 3 ?
? II度 3 1 ?
? III度 1 0 ?
表3 实验组与对照组患者术后切口疼痛评分的比较表
项目 对照组 实验组 P值
术后0-2 h 2.33±0.49 1.60±0.63 0.001
术后2-24 h 2.27±0.64 1.53±0.52 0.006
术后24-48 h 2.13±0.83 1.47±0.51 0.014
表4 实验组与对照组患者术后并发症的比较表
项目 对照组 实验组 P值
消化道出血 0 0 P＝1.00
切口感染 1 1 P＝1.00
吻合口瘘 0 0 P＝1.00
肺部感染 1 0 P＝1.00
表5 两组术后1～3天CRP(mg/L)水平对比表
分组n 对照组30 实验组30 P值
术前 10.2±0.2 9.9±0.3 >0.05
术后第1天 60±4.8 45±3.7 0.0196
术后第2天 108±3.8 86±2.5 <0.01
术后第3天 100±2.08 69±2.03 <0.01
表6 两组术后1～3天外周血氢化可的松水平对比表
分组n 对照组30 实验组30 P值
术前 127±11.2 122±10.5 0.953
术后第1天 103±3.4 33±2.6 <0.01
术后第2天 89±2.6 47±2.3 <0.01
术后第3天 85±2.8 51±2.5 <0.01
[1]
Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation.Br J Anaesth, 1997, 78(5): 606-617.
[2]
Vlug MS, Wind J, Hollmann MW, et al.LAFA study group.Laparoscopy in combination with fast track multimodal management is the best perioperative strategy in patients undergoing colonic surgery: a randomized clinical trial(LAFA-study). Ann Surg, 2011, 254(6): 868-875.
[3]
Backes JR, Bentley JC, Politi JR, et al.Dexamethasone reduces length of hospitalization and improves postoperative pain and nausea after total joint arthroplasty: a prospective, randomized controlled trial.J Arthroplasty, 2013, 28: 11-17.
[4]
Jakobsson J. Preoperative single-dose intravenous dexamethasone during ambulatory surgery: update around the benefit versus risk.Curr Opin Anaesthesiol, 2010, 23(6): 682-686.
[5]
Kardash KJ, Sarrazin F, Tessler MJ, et al.Single-dose dexamethasone reduces dynamic pain after total hip arthroplasty.Anesth Analg, 2008, 106(4): 1253-1257.
[6]
Ryu JH, Chang JE, Kim HR, et al.Ramosetron vs.ramosetron plus dexamethasone for the prevention of postoperative nausea and vomiting(PONV)after laparoscopic cholecystectomy: prospective, randomized, and double-blind study.Int J Surg, 2013, 11(2): 183-187.
[7]
Apfel CC, Kranke P, Eberhart LH, et al.Comparison of predictive models for postoperative nausea and vomiting.Br J Anaesth, 2002, 88(2): 234-240.
[8]
Koivusalo AM, Kellokumpu I, Lindgren L. Postoperative drowsiness and emetic sequelae correlate to total amount of carbon dioxide used during laparoscopic cholecystectomy.Surg Endosc, 1997, 11(1): 42-44.
[9]
Wang JJ, Tzeng JI, Ho ST, et al.The prophylactic effect of tropisetron on epidural morphine-related nausea and vomiting: a comparison of dexamethasone with saline.Anesth Analg, 2002, 94(3): 749-753.
[10]
White PF, Kehlet HImproving postoperative pain management: what are the unresolved issues？. Anesthesiology, 2010, 112(1): 220-225.
[11]
White PF.Multimodal analgesia: its role in preventing postoperative pain.Curr Opin Investig Drugs, 2008, 9(1): 76-82.
[12]
Kehlet H, Andersen LØ.Local infiltration analgesia in joint replacement: the evidence and recommendations for clinical practice.Acta Anaesthesiol Scand, 2011, 55(7): 778-784.
[13]
Ventham NT, Hughes M, O'Neill S, et al.Systematic review and meta-analysis of continuous local anaesthetic wound infiltration versus epidural analgesia for postoperative pain following abdominal surgery.Br J Surg, 2013, 100(10): 1280-1289.
[14]
Oliveira GS, Castro-Alves LJ, Nader A, et al.Transversus abdominis plane block to ameliorate postoperative pain outcomes after laparoscopic surgery: a meta-analysis of randomized controlled trials.Anesth Analg, 2014, 118(2): 454-463.
[15]
Lunn TH, Kehlet H. Perioperative glucocorticoids in hip and knee surgery-benefit vs.harm？A review of randomized clinical trials.Acta Anaesthesiol Scand, 2013, 57(7): 823-834.
[16]
Waldron NH, Jones CA, Gan TJ, et al.Impact of perioperative dexamethasone on postoperative analgesia and side-effects: systematic review and meta-analysis.Br J Anaesth, 2013, 110(2): 191-200.
[1] 宋玟焱, 杜美君, 陈佳丽, 石冰, 黄汉尧. 唇腭裂手术围手术期疼痛管理的研究进展及基于生物材料治疗新方法的展望[J/OL]. 中华口腔医学研究杂志(电子版), 2024, 18(06): 397-405.
[2] 易颖煜, 朱亚琴. 口颌面疼痛的研究进展[J/OL]. 中华口腔医学研究杂志(电子版), 2024, 18(05): 300-306.
[3] 罗青杉, 梅海涛, 郝家领, 蔡锦锋, 周润楷, 温玉刚. 连接蛋白43通过调控细胞周期抑制结直肠癌的增殖机制研究[J/OL]. 中华普通外科学文献(电子版), 2024, 18(05): 344-349.
[4] 徐逸男. 不同术式治疗梗阻性左半结直肠癌的疗效观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 72-75.
[5] 杜伟, 廖土明, 李雄才, 关刚强, 何燊, 吴佳桥, 朱和荣. 2%利多卡因凝胶和润滑剂凝胶在女性尿流动力学检查中应用的随机对照研究[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(06): 613-617.
[6] 闫亚飞, 范学圣, 张舰, 吴勇. 经腹腹膜前疝修补术治疗复发腹股沟疝的临床效果[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(05): 552-556.
[7] 韩加刚, 王振军. 梗阻性左半结肠癌的治疗策略[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 450-458.
[8] 梁轩豪, 李小荣, 李亮, 林昌伟. 肠梗阻支架置入术联合新辅助化疗治疗结直肠癌急性肠梗阻的疗效及其预后的Meta 分析[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 472-482.
[9] 严虹霞, 王晓娟, 张毅勋. 2 型糖尿病对结直肠癌患者肿瘤标记物、临床病理及预后的影响[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 483-487.
[10] 赵磊, 刘文志, 林峰, 于剑, 孙铭骏, 崔佑刚, 张旭, 衣宇鹏, 于宝胜, 冯宁. 深部热疗在改善结直肠癌术后辅助化疗副反应及生活质量中的作用研究[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 488-493.
[11] 黄海洋, 邝永龙, 陈嘉胜. 基层医院结直肠肿瘤经自然腔道取标本手术30 例分析[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 510-518.
[12] 张蔚林, 王哲学, 白峻阁, 黄忠诚, 肖志刚. 利用TCGA数据库构建基于miRNA的结直肠癌列线图预后模型[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(05): 381-388.
[13] 张伟伟, 陈启, 翁和语, 黄亮. 随机森林模型预测T1 期结直肠癌淋巴结转移的初步研究[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(05): 389-393.
[14] 韦巧玲, 黄妍, 赵昌, 宋庆峰, 陈祖毅, 黄莹, 蒙嫦, 黄靖. 肝癌微波消融术后中重度疼痛风险预测列线图模型构建及验证[J/OL]. 中华临床医师杂志(电子版), 2024, 18(08): 715-721.
[15] 蔡晓雯, 李慧景, 丘婕, 杨翼帆, 吴素贤, 林玉彤, 何秋娜. 肝癌患者肝动脉化疗栓塞术后疼痛风险预测模型的构建及验证[J/OL]. 中华临床医师杂志(电子版), 2024, 18(08): 722-728.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号