本文關(guān)鍵詞： 手術(shù)后惡心嘔吐 新輔助治療 地塞米松 丙泊酚 乳房切除術(shù) 改良根治性　出處：《北京大學(xué)學(xué)報(bào)(醫(yī)學(xué)版)》2015年04期 　論文類型：期刊論文

【摘要】：目的:評(píng)估地塞米松對(duì)新輔助化療(術(shù)前化療)后乳腺癌改良根治術(shù)術(shù)后惡心嘔吐(postoperative nausea and vomiting,PONV)的預(yù)防效果。方法:新輔助化療后行乳腺癌改良根治術(shù)的女性乳腺癌患者280例,18~60歲,隨機(jī)分為兩組,每組140例:(1)D組:實(shí)驗(yàn)組,術(shù)前給予10 mg地塞米松靜脈滴注;(2)C組:對(duì)照組,術(shù)前給予2 m L生理鹽水作為安慰劑靜脈滴注。每組患者再分為兩亞組,每組70例,分別應(yīng)用丙泊酚全憑靜脈麻醉(total intravenous anesthesia,TIVA)(P亞組)和七氟醚維持吸入全身麻醉(S亞組)。所有患者均進(jìn)行標(biāo)準(zhǔn)的全身麻醉操作,手術(shù)結(jié)束前30 min靜脈滴注昂丹司瓊(ondansetron)8 mg。隨訪術(shù)后24 h內(nèi)患者惡心嘔吐的發(fā)生率,并對(duì)PONV的影響因素進(jìn)行Logistic回歸分析。檢測(cè)因素包括年齡、體重指數(shù)(body mass index,BMI)、手術(shù)時(shí)間、術(shù)后疼痛程度、暈動(dòng)病史/既往PONV史、是否應(yīng)用地塞米松以及麻醉方法。結(jié)果:術(shù)后24 h內(nèi)D組患者惡心嘔吐的發(fā)生率明顯低于C組患者(11.4%vs.20.7%,P=0.034);術(shù)后0~2 h D組患者PONV的發(fā)生率低于C組患者(1.4%vs.6.4%,P=0.031);術(shù)后2~24 h D組患者PONV的發(fā)生率與C組患者差異無顯統(tǒng)計(jì)學(xué)意義(10.7%vs.17.9%,P=0.088)。術(shù)后24 h內(nèi)各時(shí)段,D組與C組內(nèi)丙泊酚全憑靜脈麻醉亞組與吸入麻醉亞組PONV的發(fā)生率比較差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。Logistic回歸分析顯示地塞米松對(duì)新輔助化療后乳腺癌改良根治術(shù)患者術(shù)后惡心嘔吐有預(yù)防效果(OR=0.447,P=0.030),暈動(dòng)癥/PONV病史是術(shù)后惡心嘔吐的危險(xiǎn)因素(OR=15.730,P0.001)。結(jié)論:術(shù)前應(yīng)用地塞米松可明顯降低新輔助化療后乳腺癌改良根治術(shù)患者術(shù)后惡心嘔吐的發(fā)生率。
[Abstract]:Objective: to evaluate the preventive effect of dexamethasone on postoperative nausea and vomiting after modified radical mastectomy for breast cancer after neoadjuvant chemotherapy (preoperative chemotherapy). Methods: 280 female patients with breast cancer undergoing modified radical mastectomy after neoadjuvant chemotherapy were enrolled in this study. They were randomly divided into two groups: group D (n = 140): experimental group, treated with 10 mg dexamethasone intravenously before operation, group C: control group, treated with 2 mL saline as a placebo before operation. Each group was subdivided into two subgroups, 70 cases in each group. Propofol was given total intravenous the anesthesia (TIVAZP subgroup) and sevoflurane (sevoflurane maintained inhaled general anesthesia subgroup S) respectively. All patients underwent standard general anesthesia. Ondansetron 8 mg was infused 30 min before the end of the operation. The incidence of nausea and vomiting was observed within 24 hours after operation, and the influencing factors of PONV were analyzed by Logistic regression analysis. The factors included age, body mass index (BMI), body mass index (BMI), and duration of operation. The degree of postoperative pain, history of motion sickness / previous history of PONV, Results: the incidence of nausea and vomiting in group D was significantly lower than that in group C within 24 hours after operation. Results: the incidence of PONV in group D was significantly lower than that in group C (11.4vs.20.7); the incidence of PONV in group D was lower than that in group C (1.4vs.6.4); the incidence of PONV in group D was lower than that in group C at 224h. There was no significant difference in the incidence of PONV between group C and group C (10.7vs.17.9). There was no significant difference in the incidence of PONV between group D and group C within 24 hours after operation. Logistic regression analysis showed that dexamethasone had preventive effect on postoperative nausea and vomiting in patients undergoing modified radical mastectomy after neoadjuvant chemotherapy. The history of motion sickness / PONV was a risk factor for postoperative nausea and vomiting. Conclusion: preoperative use of dexamethasone is a risk factor for postoperative nausea and vomiting. It can significantly reduce the incidence of postoperative nausea and vomiting after modified radical mastectomy for breast cancer after neoadjuvant chemotherapy.
【作者單位】： 北京大學(xué)腫瘤醫(yī)院;北京市腫瘤防治研究所麻醉科;惡性腫瘤發(fā)病機(jī)制及轉(zhuǎn)化研究教育部重點(diǎn)實(shí)驗(yàn)室;
【分類號(hào)】：R614.2;R737.9

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本文編號(hào)：1511141