微创医学

目的探讨内关穴注射地塞米松预防妇科腹腔镜手术后恶心呕吐(PONV)的效果及其对肾素-血管紧张素-醛固酮系统(RAAS)应激反应的影响。方法选择拟接受腹腔镜手术治疗的妇科疾病患者400例，按随机数字表法分为4组，各100例。4组均接受相同的标准化全身麻醉。麻醉诱导后5 min，A组未加任何干预，B组静脉注射地塞米松10 mg，C组于双侧内关穴注射生理盐水各1.0 mL，D组于双侧内关穴注射地塞米松各1.0 mL（各5 mg）。比较4组患者的麻醉指标、术后72 h内恶心呕吐发生率。于诱导前(T1)、手术开始后30 min(T2)和手术结束时(T3)抽静脉血，检测并比较肾素、血管紧张素Ⅱ(ANGⅡ)、醛固酮(ALD)水平。结果4组患者的手术时间、麻醉时间、术中输液量、术中出血量、丙泊酚用量、术后苏醒时间、拔除气管导管时间比较，差异均无统计学意义（均P＞0.05）。术后0～24 h，B组与C组恶心、呕吐及补救性镇吐比例差异无统计学意义（均P＞0.05）；其余各组恶心、呕吐及补救性镇吐比例两两比较，差异均有统计学意义（均P＜0.05）。术后24～48 h，D组恶心、呕吐发生率明显低于A组、B组、C组，补救性镇吐比例低于A组（均P＜0.05）；其余各组恶心、呕吐及补救性镇吐率两两比较，差异均无统计学意义（均P＞0.05）。术后48～72 h，D组恶心、呕吐及补救性镇吐比例低于A组（均P＜0.05）；其余各组恶心、呕吐及补救性镇吐率两两比较，差异均无统计学意义（均P＞0.05）。B组、C组、D组恢复进食时间均早于A组（均P＜0.05）。4组恢复运动时间比较，差异无统计学意义（P＞0.05）。4组组间肾素、ANGⅡ和ALD水平差异均有统计学意义（均P＜0.05）；肾素、ANGⅡ和ALD水平有随时间变化的趋势，时间与组别间有交互作用（P＜0.05）。结论内关穴注射地塞米松可明显降低妇科腹腔镜手术PONV发生率，对应激反应也有较好的抑制作用。

ObjectiveTo investigate the effect of dexamethasone injected in the Neiguan acupoint in preventing postoperative nausea and vomiting (PONV) in gynecological laparoscopy surgery, and its effect on the stress response of the renin-angiotensin-aldosterone system (RAAS). MethodsA total of 400 patients with gynecological diseases undergoing laparoscopic surgery were selected and divided into four groups according to the random number table method, with 100 cases in each group. All the four groups received the same standardized general anesthesia. Five minutes after anesthesia induction, group A did not undergo any intervention, group B received an intravenous injection of dexamethasone with 10 mg, group C was injected with 1.0 mL of normal saline at bilateral Neiguan acupoints, and group D was injected with dexamethasone at bilateral Neiguan acupoints, with 1.0 mL (5 mg) at each side. The anesthesia indexes and the incidence of nausea and vomiting within 72 hours after operation were compared between the 4 groups. The venous blood was drawn to detect and compare the levels of renin, angiotensin Ⅱ (ANGⅡ) and aldosterone (ALD) before induction (T1), 30 minutes after the start of the operation (T2) and at the end of the operation (T3). ResultsThere were no statistically significant differences in operation time, anesthesia time, intraoperative infusion volume, intraoperative blood loss, propofol dosage, postoperative resuscitation time and extubation time between the four groups (all P＞0.05). During 0-24 hours after operation, there were no statistically significant differences in the proportion of nausea, vomiting and remedial anti-vomiting between group B and group C (all P＞0.05), while there were statistically significant differences in the abovementioned indicators as compared with the other groups in pairs (all P＜0.05). During 24-48 hours after operation, the incidence of nausea and vomiting in group D was significantly lower than that in group A, group B and group C, and the proportion of remedial anti-vomiting in group D was lower than that in group A (all P＜0.05), while there were no statistically significant differences in indicators mentioned above as compared with the other groups in pairs (all P＞0.05). During 48-72 hours after operation, group D yielded a lower proportion of nausea, vomiting and remedial anti-vomiting as compared to group A, but there were no statistically significant differences in the proportion of nausea, vomiting and remedial anti-vomiting as compared with the other groups in pairs (all P＞0.05). The resumption of feeding time in group B, C, D was earlier than that in group A (all P＜0.05), and there was no statistically significant difference in the recovery to exercise time between the 4 groups (P＞0.05). There were statistically significant differences in the levels of renin, ANG Ⅱ and ALD between the four groups (all P＜0.05); the levels of renin, ANGⅡ and ALD tended to change over time, and there was an interaction between time and groups. ConclusionDexamethasone injected in the Neiguan acupoint can significantly reduce the incidence of PONV in gynecological laparoscopy surgery and has a good inhibitory effect on the stress response.