IBD: 围手术期使用地塞米松可以减少炎症性肠病患者手术后的过度炎症反应和肠梗阻的发生

2021-10-21 MedSci原创 MedSci原创

尽管生物制剂被广泛用于治疗炎症性肠病 (IBD),但手术仍然是很大一部分患者的主要治疗选择。

      尽管生物制剂被广泛用于治疗炎症性肠病 (IBD),但手术仍然是很大一部分患者的主要治疗选择。据报道,溃疡性结肠炎 (UC) 重症住院患者的结肠切除率接近 27%,而高达 75% 的克罗恩病 (CD) 患者最终都要接受手术。众所周知,C 反应蛋白 (CRP) 或白介素 6 (IL-6) 水平与全身炎症反应增加和术后并发症增加有关,从理论上讲,减少术后过度炎症反应,如微创手术和加速康复外科理念的运用 (ERAS) ,可能会减少术后感染并加速术后恢复。地塞米松 (DM) 是一种有效的糖皮质激素,据报道可减少术后全身炎症反应 (SIRS) 和手术后并发症的发生。本研究旨在评估围手术期使用地塞米松在减少IBD手术后肠梗阻中的作用。

 

      研究人员将纳入的患者随机分为两组,一组接受手术麻醉诱导后静脉注射8毫克剂量的地塞米松(n = 151)或另一组接受安慰剂(n = 151)治疗。主要观察结果是术后肠梗阻的发生率。次要观察结果包括恶心或呕吐的发生率、首次排气和大便的时间、术后疼痛、住院时间和手术并发症的发生率。

 

       意向性治疗分析显示,接受地塞米松治疗的患者术后肠梗阻的发生率较低(22.5% VS 38.4%;P=0.003),首次排便时间更短(28小时VS 48小时,P < 0.001),术后住院时间缩短(9.0 VS 10.0 天;P= 0.002), 与对照组相比,使用地塞米松的患者术后疼痛减轻(P < 0.05)。此外,术后恶心或呕吐(P  = 0.531)、术后主要并发症(P  = 0.165)或手术部位感染(P = 0.337) 两组之间没有差异。

 

       本项研究证实麻醉诱导时单次静脉注射8毫克地塞米松可降低炎症性肠病患者术后肠梗阻的发生率、术后疼痛的强度,并缩短接受择期手术的 IBD 患者的术后住院时间。

 

 

原始出处:

Tenghui Zhang. Et al. Randomized Controlled Trial: Perioperative Dexamethasone Reduces Excessive Postoperative Inflammatory Response and Ileus After Surgery for Inflammatory Bowel Disease. Inflammatory Bowel Diseases.2021.

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    2021-10-23 bnurmamat
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