摘要
目的评价麻醉诱导前内关穴注射地塞米松对老年高血压患者甲状腺手术后恶心呕吐和应激的影响。方法选择2022年5-10月在山西医科大学第一医院择期接受甲状腺手术的老年高血压患者200例,年龄66~90岁,美国麻醉医师协会(ASA)分级Ⅱ~Ⅲ级,按照随机数字表法分为2组(每组100例):术前内关穴注射地塞米松组(P6D组)以及术前静脉注射地塞米松组(IVD组),术前注射地塞米松剂量为10 mg(静脉注射2 m1∶10 mg,或双侧内关穴各注射1 ml∶5 mg)。监测两组患者术前以及术后6 h、12 h、24 h的血糖(GLU)、皮质醇(CORT)、肾上腺素(E)浓度以及5-羟色胺(5-HT)浓度,记录术后0~6 h、6~12 h及12~24 h两组患者发生恶心呕吐的例数及其严重程度评分,术后24 h采用15项恢复质量表(QoR-15)评价患者整体恢复程度,统计患者48 h出院率。结果与IVD组相比,P6D组术后3个时间点血GLU、CORT、E及5-HT浓度降低(P<0.001),术后0~6 h患者恶心呕吐发生率(12.0%vs.30.0%)及其严重程度[1.0(0.0,1.0)vs.4.0(2.0,5.0)]降低(P<0.05),QoR-15评分[(118.55±10.43)分vs.(107.85±8.67)分,P<0.001]升高,48 h出院率升高(P<0.001)。结论麻醉诱导前内关穴注射地塞米松可显著降低老年高血压患者术后0~6 h内的恶心呕吐发生率及严重程度,抑制术后应激,提高患者整体恢复效果,缩短住院时间。
Objective To investigate the effect of injection of dexamethasone at Neiguan(P6)acupoint before anesthesia induction on nausea,vomiting and stress in elderly patients with hypertension after thyroid surgery.Methods Totally 200 elderly patients with hypertension,aged 66~90 years old,who underwent thyroid surgery at the First Hospital of Shanxi Medical University from May to October 2022,were divided into 2 groups(100 cases in each group)according to the random number table method:the group receiving preoperative injection of dexamethasone at Neiguan acupoint(P6D group)and the group receiving preoperative intravenous injection of dexamethasone(IVD group).The dose of preoperative injection of dexamethasone was 10 mg(intravenous injection of 2 ml∶10 mg,or bilateral Neiguan acupoint injection of 1 ml∶5 mg).The concentrations of blood glucose(GLU),cortisol(CORT),epinephrine(E)and 5-hydroxytryptamine(5-HT)in the 2 groups were monitored before and at 6 h,12 h and 24 h after surgery;the number of cases of nausea and vomiting in the 2 groups at 0~6 h,6~12 h and 12~24 h after surgery and the severity scores were recorded.The recovery degree was assessed by 15-item Quality of Recovery(QoR-15)at 24 h after operation.The 48-hour discharge rate of patients after operation was recorded.Results Compared with IVD group,the levels of blood GLU,CORT,E and 5-HT in P6D group were lower at 3 time points after surgery(P<0.001);the incidence of nausea and vomiting(12.0%vs.30.0%)and its severity[1.0(0.0,1.0)vs.4.0(2.0,5.0)]in P6D group were lower at 0~6 h after surgery(P<0.05);QoR-15 score(118.55±10.43 vs.107.85±8.67,P<0.001)in P6D group was higher;the rate of 48-hour discharge in P6D group was higher(P<0.001).Conclusion Injection of dexamethasone at Neiguan acupoint before anesthesia induction can significantly reduce the incidence and severity of nausea and vomiting within 0~6 h after thyroid surgery in elderly patients with hypertension,inhibit the postoperative stress,improve the overall recovery effect,and shorten the length of
作者
李花
姚小蓉
郭海鹏
杨玲
Li Hua;Yao Xiaorong;Guo Haipeng;Yang Ling(Graduate Student,College of Anesthesiology,Shanxi Medical University,Taiyuan 030000,China;Department of Anesthesiology,First Hospital of Shanxi Medical University,Taiyuan 030000,China)
出处
《实用药物与临床》
CAS
2024年第2期111-115,共5页
Practical Pharmacy and Clinical Remedies
关键词
地塞米松
内关穴
穴位注射
甲状腺手术
老年患者
恶心呕吐
应激
Dexamethasone
Neiguan acupoint
Acupoint injection
Thyroid surgery
Elderly patients
Nausea and vomiting
Stress
