地塞米松对2型糖尿病患者腹腔镜手术围术期血糖和术后恶心呕吐的影响

Effect of dexamethasone on perioperative blood glucose and postoperative nausea and vomiting in patients with type 2 diabetes mellitus after laparoscopic surgery

中文关键词: 地塞米松  术后恶心呕吐  2型糖尿病  腹腔镜手术

英文关键词: Dexamethasone  Postoperative nausea and vomiting  Type 2 diabetes mellitus  Laparoscopic surgery

中文摘要:

      
目的：探讨术前静注地塞米松5 mg对行腹腔镜手术的2型糖尿病患者围术期血糖和术后恶心呕吐（PONV）的影响。
方法：选择2023年11月至2024年12月行腹腔镜手术的2型糖尿病患者62例，男32例，女30例，年龄≥18岁，BMI≤30.0 kg/m²，ASA Ⅱ或Ⅲ级，糖化血红蛋白（HbA1c）≤9.5%。采用随机数字表法将患者分为两组：地塞米松组（D组）和对照组（C组）,每组31例。D组麻醉诱导前静注地塞米松5 mg，C组麻醉诱导前静注等容量生理盐水。记录术后72 h内PONV的发生情况。记录入室、术毕、术后24、48 h血糖，并分别计算术后24、48 h与入室血糖的差值。记录术后住院时间、住院期间伤口感染、伤口愈合延迟的发生情况。
结果：与C组比较，D组术后72 h内PONV发生率明显降低(P＜0.05)，术后24 h与入室血糖差值明显升高（P＜0.05）。两组入室、术毕、术后24、48 h血糖、术后住院时间、住院期间伤口感染和伤口愈合延迟发生率差异均无统计学意义。
结论：2型糖尿病患者腹腔镜手术前静注地塞米松5 mg可以有效降低PONV发生率，不增加伤口感染及伤口愈合延迟的风险，但需严格监测血糖。

英文摘要:

      
Objective: To investigate the effect of preoperative intravenous injection of dexamethasone 5 mg on perioperative blood glucose and postoperative nausea and vomiting (PONV) in patients with type 2 diabetes mellitus after laparoscopic surgery.
Methods: Sixty-two patients with type 2 diabetes mellitus who underwent laparoscopic surgery from November 2023 to December 2024 were selected, 32 males and 30 females, aged ≥ 18 years, BMI ≤ 30.0 kg/m², ASA physical status Ⅱ or Ⅲ, glycosylated hemoglobin (HbA1c) ≤ 9.5%. The patients were divided into two groups using a random number table method: dexamethasone group (group D) and control group (group C), 31 patients in each group. Dexamethasone 5 mg was intravenously injected in group D before anesthesia induction, while the same amount of normal saline was injected into group C before anesthesia induction. The occurrence of PONV, the blood glucose at admission to the operating room, the end of the operation, 24 and 48 hours after surgery were recorded. The differences in blood glucose between 24 hours after surgery and admission to the operating room, and between 48 hours after surgery and admission to the operating room were calculated. The duration of postoperative hospital stay, the patient's number of occurred wound infection, and delayed wound healing during hospitalization were recorded.
Results: Compared with group C, the incidence of PONV was significantly decreased in group D (P < 0.05), and the difference in blood glucose between 24 hours after surgery and admission to the operating room was significantly increased in group D (P < 0.05). There were no significant differences in the blood glucose at admission to the operating room, the end of the operation, 24 and 48 hours after surgery, postoperative hospital stay, and the occurrence of wound infection and delayed healing during hospitalization between the two groups.
Conclusion: Preoperative intravenous injection of dexamethasone 5 mg in type 2 diabetic mellitus patients after laparoscopic surgery can effectively reduce the incidence of postoperative nausea and vomiting without increasing the risk of infection and delaying wound healing, but blood glucose needs to be strictly monitored.