地塞米松对新辅助化疗后乳腺癌患者术后恶心呕吐发生率的影响

发布时间：2018-02-14 16:42

本文关键词： 手术后恶心呕吐新辅助治疗地塞米松丙泊酚乳房切除术改良根治性　出处：《北京大学学报(医学版)》2015年04期 　论文类型：期刊论文

【摘要】：目的:评估地塞米松对新辅助化疗(术前化疗)后乳腺癌改良根治术术后恶心呕吐(postoperative nausea and vomiting,PONV)的预防效果。方法:新辅助化疗后行乳腺癌改良根治术的女性乳腺癌患者280例,18~60岁,随机分为两组,每组140例:(1)D组:实验组,术前给予10 mg地塞米松静脉滴注;(2)C组:对照组,术前给予2 m L生理盐水作为安慰剂静脉滴注。每组患者再分为两亚组,每组70例,分别应用丙泊酚全凭静脉麻醉(total intravenous anesthesia,TIVA)(P亚组)和七氟醚维持吸入全身麻醉(S亚组)。所有患者均进行标准的全身麻醉操作,手术结束前30 min静脉滴注昂丹司琼(ondansetron)8 mg。随访术后24 h内患者恶心呕吐的发生率,并对PONV的影响因素进行Logistic回归分析。检测因素包括年龄、体重指数(body mass index,BMI)、手术时间、术后疼痛程度、晕动病史/既往PONV史、是否应用地塞米松以及麻醉方法。结果:术后24 h内D组患者恶心呕吐的发生率明显低于C组患者(11.4%vs.20.7%,P=0.034);术后0~2 h D组患者PONV的发生率低于C组患者(1.4%vs.6.4%,P=0.031);术后2~24 h D组患者PONV的发生率与C组患者差异无显统计学意义(10.7%vs.17.9%,P=0.088)。术后24 h内各时段,D组与C组内丙泊酚全凭静脉麻醉亚组与吸入麻醉亚组PONV的发生率比较差异均无统计学意义(P0.05)。Logistic回归分析显示地塞米松对新辅助化疗后乳腺癌改良根治术患者术后恶心呕吐有预防效果(OR=0.447,P=0.030),晕动症/PONV病史是术后恶心呕吐的危险因素(OR=15.730,P0.001)。结论:术前应用地塞米松可明显降低新辅助化疗后乳腺癌改良根治术患者术后恶心呕吐的发生率。
[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.
【作者单位】：北京大学肿瘤医院;北京市肿瘤防治研究所麻醉科;恶性肿瘤发病机制及转化研究教育部重点实验室;
【分类号】：R614.2;R737.9

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