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目的观察术前单次应用糖皮质激素对结直肠癌术后恶心、呕吐、疼痛及应激的影响。方法选取2013年11月至2014年4月间在河北医科大学第四医院外二科接受手术治疗的60例结直肠癌患者。患者随机分成两组:对照组:腹腔镜手术联合加速康复外科;实验组:在腹腔镜手术联合加速康复外科的基础上,术前单次应用氟美松5 mg静注。分别于术后0-2 h、2-24 h、24-48 h进行恶心、呕吐及疼痛评分,测定术前1天及术后1-3天的C反应蛋白(CRP)及外周血氢化可的松水平。结果与对照组相比,术前应用氟美松可以明显缓解术后0-2h、2-24h的恶心、呕吐(P<0.05);对照组和实验组术后0-2h疼痛评分分别为2.33±0.49 vs 1.60±0.63(P=0.001),2-24h则为2.27±0.64vs 1.53±0.52(P=0.006),而24-48 h为2.13±0.83 vs 1.47±0.51(P=0.014)。术后1-3d,实验组的CRP和外周血氢化可的松水平均低于对照组(P<0.01)。结论术前单次应用糖皮质激素能缓解结直肠癌术后恶心、呕吐及切口疼痛及应激反应,且安全可行。
Objective To observe the effect of a single preoperative glucocorticoid on postoperative nausea, vomiting, pain and stress in patients with colorectal cancer. Methods From November 2013 to April 2014, 60 patients with colorectal cancer undergoing surgical treatment in the second department of the Fourth Hospital of Hebei Medical University were selected. Patients were randomly divided into two groups: control group: laparoscopic surgery combined with accelerated rehabilitation surgery; experimental group: based on laparoscopic surgery combined with accelerated rehabilitation surgery, single preoperative application of 5 mg intravenous dexamethasone. Nausea, vomiting and pain scores were assessed at 0-2 h, 2-24 h, and 24-48 h after surgery respectively. C-reactive protein (CRP) and peripheral blood hydrogenation The level of pine. Results Compared with the control group, preoperative application of dexamethasone could relieve nausea and vomiting at 0-2h and 2-24h postoperatively (P0.05). The pain scores of control group and experimental group at 0-2h postoperatively were 2.33 ± 0.49 vs 1.60 ± 0.63 (P = 0.001), and 2.27 ± 0.64 vs 1.53 ± 0.52 at 2-24h (P = 0.006) and 2.13 ± 0.83 vs 1.47 ± 0.51 at 24-48 h (P = 0.014). The level of CRP and the level of hydrocortisone in the experimental group were lower than those in the control group 1-3 days after operation (P <0.01). Conclusions A single preoperative application of glucocorticoid can relieve postoperative nausea, vomiting, incision pain and stress response in colorectal cancer, and is safe and feasible.