异丙酚与地塞米松预防耳鼻喉科手术后恶心呕吐的效果

恶心呕吐是常见的术后并发症，可影响患者的康复，导致水电解质酸碱平衡紊乱，误吸，吸入性肺炎等。其病因尚未完全清楚，可能与性别、年龄、手术、麻醉药如阿片类等因素相关，而有效的预防方法还在探索中，近日在Anesthesiol Res Pract. 杂志发表了一篇题为Effectiveness of Propofol versus Dexamethasone for Prevention of Postoperative Nausea and Vomiting in Ear, Nose, and Throat Surgery in Tikur Anbessa Specialized Hospital and Yekatit 12th Hospital, Addis Ababa, Ethiopia. 的文章，比较了异丙酚和地塞米松对术后恶心呕吐的预防效果。

异丙酚与地塞米松预防耳鼻喉科手术后恶心呕吐的效果比较

背景

术后恶心呕吐（PONV）仍然是耳鼻喉科手术后常见的、令人不快和极度痛苦的经历。在耳鼻喉科手术中，预防性使用地塞米松和异丙酚可显著降低PONV的发生率。然而，这两种药物的相对有效性尚未得到评估。本研究的目的是比较异丙酚和地塞米松预防耳鼻喉科手术后PONV的效果。

方法

本研究共入选80名ASA I~II级、年龄18-65岁、计划于2017年12月20日至2018年3月20日进行耳鼻喉科手术的患者。将患者随机分为A组和B组，术后立即静脉注射地塞米松10 mg/kg，B组静脉注射异丙酚0.5 mg/kg，随访时间相同。在给药后6、12和24小时观察PONV的发生率。分别采用独立t检验和Mann-Whitney检验比较两组间的对称数据和非对称数据。分类资料采用卡方检验，p值<0.05为显著性水平。

结果

术后24小时内，异丙酚组和地塞米松组的PONV发生率分别为35%和25%。

地塞米松组和异丙酚组在12-24小时的PONV发生率（0%对22.5%，p ≤ 0.001）和使用止吐药的比例（0%对5%，p =0.02）。

24小时内地塞米松组和异丙酚组分别有5%和15%（摘要里是12.5%，但图片及原文里是15%）的患者出现中度PONV，而无一例出现严重的PONV。

(感觉这张图有点小问题，集中在0-24那一栏)

其他并发症情况

结论

地塞米松预防PONV的效果优于异丙酚，抢救性止吐药用量较低。

(总体感觉，结果不够详细，比如总的恶心呕吐发生率是否有统计学差异，没有写明，只有发生率，图表和文字描述也存在一定不符的地方，仅供参考吧，这个杂志是SCI杂志吗？)

Effectiveness of Propofol versus Dexamethasone for Prevention of Postoperative Nausea and Vomiting in Ear, Nose, and Throat Surgery in Tikur Anbessa Specialized Hospital and Yekatit 12th Hospital, Addis Ababa, Ethiopia

Background

Postoperative nausea and vomiting (PONV) remain as common and unpleasant and highly distressful experience following ear, nose, and throat surgery. During ENT surgery, the incidence of PONV could be significantly reduced in patients who receive dexamethasone and propofol as prophylaxis. However, the comparative effectiveness of the two drugs has not been assessed. The aim of this study was to compare the effectiveness of propofol and dexamethasone for prevention of PONV in ear, nose, and throat surgery.

Methods

This study was conducted in 80 patients, with ASA I and II, aged 18–65 years, and scheduled for ENT surgery between December 20, 2017, and March 20, 2018. Patients were randomly assigned to Group A and Group B. Immediately after the procedure, Group A patients received single dose of intravenous (IV) dexamethasone (10 mg/kg) and Group B patients were given propofol (0.5 mg/kg, IV), and equal follow-up was employed. The incidence of PONV was noted at 6th, 12th, and 24th hour of drug administration. Independent t-test and Mann–Whitney test were used for comparison of symmetric numerical and asymmetric data between groups, respectively. Categorical data were analyzed with the chi-square test, and p value of < 0.05 was considered as level of significance.

Results

The incidences of PONV throughout the 24-hour postoperative period were 35% in the propofol group and 25% in the dexamethasone group. Statistical significance was found in incidence of PONV (0% versus 22.5%) and use of antiemetic (0% versus 5%) between dexamethasone and propofol groups, respectively, at 12–24 hours. Over 24 hours, 5% in dexamethasone group and 12.5% in propofol group developed moderate PONV, while none of the participants felt severe PONV.

Conclusions

Dexamethasone was more effective than propofol to prevent PONV with lower requirements of rescue antiemetics.

 
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