地塞米松对宫颈癌患者术后认知功能的影响

目的 分析不同剂量地塞米松对宫颈癌患者术后疼痛和术后认知功能障碍(POCD)的作用。 方法 将90例择期行手术治疗的宫颈癌患者随机分为3组:低剂量地塞米松组(Dex-L组)、高剂量地塞米松组(Dex-H组)和对照组,每组30例,分别于麻醉诱导时静脉注射0.1、0.2 mg/kg地塞米松或等体积生理盐水。于术前1天及术后1、3、5、7 d使用视觉模拟评分(VAS)评价患者术后疼痛,采用简易智能量表(MMSE)测定患者认知功能分值和POCD发生率。 结果 两组地塞米松组患者术后切口静息痛VAS评分低于对照组(P＜0.05),Dex-H组患者运动痛VAS评分低于对照组(P＜0.05);Dex-L组与对照组比较,MMSE评分上升,POCD发生率下降(P＜0.05)。结论 小剂量地塞米松可降低宫颈癌患者术后疼痛和POCD发生率,而大剂量地塞米松(0.2 mg/kg)仅能降低患者的术后疼痛,对术后POCD的发生率无明显影响。

Effects of dexamethasone on postoperative cognitive function in patients undergoing radical hysterectomy

Objective To analyze the effect of different doses of dexamethasone on postoperative analgesia and cognitive dysfunction in elderly patients after radical hysterectomy. Methods 90 elderly patients undergoing radical hysterectomy were randomly divided into three groups: the low dose dexamethasone group (Dex-L), the high dose dexamethasone group (Dex-H) and the control group, with 30 cases in each. At the induction of general anesthesia, patients were intravenously injected with 0.1 mg/kg of dexamethasone, 0.2 mg/kg of dexamethasone or same volume of saline. At 1d before operation and 1 d, 3 d, 5 d, 7 d after operation, the visual analog score (VAS) was used to assess incision pain (in resting and exercise) of patients, the mini-mental state examination (MMSE) was applied to evaluate the cognitive function and the incidences of postoperative cognitive dysfunction (POCD) of patients. Results The VAS resting scores of Dex-H and Dex-L groups and the VAS exercise score of Dex-H group were significantly lower than those of the control group at every time point after operation (P<0.01). Compared to the control group, the MMSE score of Dex-L group increased and the incidence of POCD reduced after operation (P<0.05). Conclusion The low dose dexamethasone (0.1 mg/kg) can reduce incision pain as well as the incidence of POCD in elderly patients after radical hysterectomy, while the high dose dexamethasone (0.2 mg/kg) can only reduce incision pain, it shows no effects on the POCD incidence in elderly patients after radical hysterectomy.