地塞米松的应用及研究进展-----以其在胸腔镜肺叶切除围手术期中的应用为例
Journal: Basic Medical Theory Research DOI: 10.12238/bmtr.v6i4.8485
Abstract
目的：研究地塞米松在胸腔镜肺叶切除围手术期的应用效果及研究进展。方法：采用文献研究法、试验对比法进行研究,采用阅读国内外文献的方式,分析地塞米松在胸腔镜肺叶切除围手术期的研究进展。选取某医院2023年6~2024年3月期间收治的50例患者,这些患者均通过三孔胸腔镜辅助下行肺叶切除术,随机分为对照组和试验组两组,每组患者各25例,其中,对照组采取常规处理方式,试验组采取麻醉诱导前予地塞米松(0.5mg/kg)静脉注射方式。手术后比较两组患者的术后并发症和术后住院日,并根据视觉模拟评分量表(visualanalgesiascale,VAS),评估患者术后12h、24h、48h、72h活动及静息时的疼痛情况。结果：文献研究表明于神经周围联合注射局部麻醉药及地塞米松能够延长患者神经阻滞持续时间,减轻患者术后疼痛,且静脉注射地塞米松可延长术后患者镇痛时长,降低恶心呕吐等不良反应发生率,提高用药安全性。同时实践研究结果表明,相比对照组,试验组术后住院日要短,术后并发症发生率较低,且患者活动疼痛程度与静息疼痛程度较轻,组间差异具有统计学意义(P＜0.05)。结论：地塞米松在麻醉及疼痛管理领域应用广泛,具有镇痛、延长神经阻滞时间、减少恶心呕吐等作用。实践研究佐证这一观点,麻醉诱导前予地塞米松(0.5mg/kg)静脉注射方式的应用在胸腔镜肺叶切除围手术期中具有较好的临床应用效果,值得加以推广应用。
Keywords
地塞米松；胸腔镜肺叶切除围手术；围术期；临床应用；研究进展
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[5] Weibel,S.etal.Drugs for preventing postoperative nausea and vomiting in adults after general anaesthesia:a network meta-analysis.Cochrane Database Syst Rev 10,CD012859, doi: 10.1002/14651858.CD012859.pub2(2020).
[6] De Oliveira, G. S., Jr. et al. Dose ranging study on the effect of preoperative dexamethasone on postoperative quali ty of recovery and opioid consumption after ambulatory gyna ecological surgery.Br J Anaesth 107,362-371, doi:10.1093/bja /aer156 (2011).
[7] Yeung,J.H.,Gates,S.,Naidu,B.V.,Wilson,M.J.& Gao Smith, F. Paravertebral block versus thoracic epidural for patients undergoing thoracotomy.Cochrane Database Syst Rev 2, CD009 121,doi:10.1002/14651858.CD009121.pub2(2016).
[8] 刘艳君,王海英,赵洋&陈冬.地塞米松联合罗哌卡因胸椎旁神经阻滞对胸腔镜肺叶切除术患者镇痛效果和术后恢复的影响%J临床与病理杂志,2023(43):734-740.
[9] 韩雪.地塞米松联合罗哌卡因ESP阻滞在胸腔镜术后镇痛的应用[D].延边大学,2020.
[10] Gao,Z.,Xiao,Y.,Wang,Q.& Li,Y.Comparison of dexmedetom idine and dexamethasone as adjuvant for ropivacaine in ultra sound-guided erector spinae plane block for video-assisted thoracoscopic lobectomy surgery: a randomized, double-blind, placebo-controlled trial.
[11] Chen,J.Q.etal.Effect of Perineural Dexamethasone with Ropivacaine in Continuous Serratus Anterior Plane Block for Postoperative Analgesia in Patients Undergoing VideoAssisted Thoracoscopic Surgery.J Pain Res 15,2315-2325,doi: 10.2147/JPR.S372071 (2022).
[12] Yang,H.et al.Evaluating Modified Ultrasound-Guided Serratus Anterior Plane Block for Enhanced Postoperative Recovery in Thoracoscopic Lobectomy Patients. Med Sci Monit 30, e942757, doi:10.12659/MSM.942757(2024).
[13] 李杰.肋间神经阻滞对胸腔镜手术后镇痛效果的系统评价与Meta分析%J中国胸心血管外科临床杂志,2022(29):478-487.
[14] 沈颖.右美托咪定与地塞米松复合罗哌卡因对胸腔镜直视下肋间神经阻滞效果的影响[D].上海交通大学,2021.
[15] Zhang,P.,Liu,S.,Zhu,J.,Rao,Z.& Liu,C. Dexamethasone and dexmedetomidine as adjuvants to local anesthetic mixture in intercostal nerve block for thoracoscopic pneumonectomy:a prospective randomized study. Reg Anesth Pain Med, doi:10. 1136/rapm-2018-100221(2019).
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[18] Maher,D.P.et al. The Combination of IV and Perineural Dexamethasone Prolongs the Analgesic Duration of Intercostal Nerve Blocks Compared with IV Dexamethasone Alone. Pain Med 18,1152-1160, doi:10.1093/pm/pnw149 (2017).
[19] Weibel, S. et al. Drugs for preventing postoperative nausea and vomiting in adults after general anaesthesia: a network meta-analysis.
[20] Park,H. J. et al. Effects of Intravenous Dexamethasone on Glycemic Control in Patients With Type 2 Diabetes Mellitus After Total Knee Arthroplasty.
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