2025 年第 8 期 第 20 卷

地塞米松联合术中胃肠减压对Baska喉罩正压通气胆囊切除术患者术后恶心呕吐的影响

Effect of dexamethasone combined with intraoperative gastrointestinal decompression on postoperative nausea and vomiting in patients undergoing cholecystectomy with Baska laryngeal mask airway positive pressure ventilation

作者：王涛1胡先蓉2寇森3晏子俊4张帮健2

英文作者：Wang Tao1 Hu Xianrong2 Kou Sen3 Yan Zijun4 Zhang Bangjian2

单位：1川北医学院麻醉学系，南充637000；2四川省攀枝花市中心医院麻醉科，攀枝花617000；3四川省攀枝花市中心医院超声科，攀枝花617000；4四川省攀枝花市中心医院药学部，攀枝花617000

英文单位：1Department of Anesthesiology North Sichuan Medical University Nanchong 637000 China; 2Department of Anesthesiology Panzhihua Central Hospital Sichuan Province Panzhihua 617000 China; 3Department of Ultrasound Panzhihua Central Hospital Sichuan Province Panzhihua 617000 China; 4Department of Pharmacy Panzhihua Central Hospital Sichuan Province Panzhihua 617000 China

关键词：胆囊切除术；地塞米松；术后恶心呕吐；Baska喉罩；胃肠减压

英文关键词：Cholecystectomy;Dexamethasone;Postoperativenauseaandvomiting;Baskalaryngealmask;Gastrointestinaldecompression

• 摘要：

• 目的 探讨地塞米松联合术中胃肠减压对Baska喉罩正压通气患者术后恶心呕吐的影响。方法 选取2023年12月至2024年6月于四川省攀枝花市中心医院行Baska喉罩正压通气腹腔镜下胆囊切除术的日间手术患者240例。简单随机分为空白对照组（A组）、地塞米松组（B组）、胃肠减压组（C组）和地塞米松联合胃肠减压组（D组），各60例。麻醉诱导前B组和D组静脉注射地塞米松4 mg，喉罩置入后C组和D组置入吸痰管行胃肠减压。分别于麻醉诱导前（T0）、喉罩置入成功后（T1）、拔除喉罩后(T2)使用超声测量并计算胃窦部面积。观察比较4组患者一般资料及麻醉手术情况、T0、T1、T2时点胃窦部面积变化以及术后1、6和24 h胃胀气、恶心、呕吐、咽痛、声嘶的发生情况。结果  4组患者的一般资料、手术情况、T0、T1时点胃窦部面积差异均无统计学意义(均P＞0.05)。T2时点，A组、B组胃窦部面积明显大于C组、D组（均P＜0.05）。4组患者术后1、6 h胃胀气、恶心、呕吐发生率，术后24 h恶心发生率差异均有统计学意义（均P＜0.05）。D组术后1、6 h恶心、呕吐［术后1 h：15.0%（9/60）比36.7%（22/60）、10.0%（6/60）比30.0%（18/60）；术后6 h：10.0%（6/60）比51.7%（31/60）、8.3%（5/60）比51.7%（31/60）］，术后6 h胃胀气以及术后24 h恶心［6.7%（4/60）比26.7%（16/60）］的发生率均低于A组（均P<0.05）。结论  地塞米松联合术中胃肠减压能够降低Baska喉罩正压通气患者术后1、6 h恶心、呕吐，术后6 h胃胀气以及术后24 h恶心的发生率。

• Objective To investigate the effect of dexamethasone combined with intraoperative gastrointestinal decompression on postoperative nausea and vomiting in patients with Baska laryngeal mask airway positive pressure ventilation. Methods A total of 240 patients undergoing laparoscopic cholecystectomy with Baska laryngeal mask positive pressure ventilation in Panzhihua Central Hospital, Sichuan Province from December 2023 to June 2024 were selected. They were randomly divided into blank control group (group A), dexamethasone group (group B), gastrointestinal decompression group (group C) and dexamethasone combined with gastrointestinal decompression group (group D), with 60 cases in each group. Before anesthesia induction, dexamethasone 4 mg was injected intravenously in group B and D. after laryngeal mask implantation, sputum suction tubes were placed in group C and D for gastrointestinal decompression. The areas of gastric antrum were measured and calculated by ultrasound before anesthesia induction (T0), after successful laryngeal mask implantation (T1), and after removal of laryngeal mask (T2). The general information and anesthesia operation, the changes of antral area at T0, T1, and T2, and the occurrence of flatulence, nausea, vomiting, sore throat, and hoarseness at 1, 6, and 24 h after operation were observed and compared among the four groups. Results There were no statistically significant differences in general information, operation conditions, and antral areas at T0 and T1 among the four groups (all P>0.05). At T2, the areas of gastric antrum in group A and B were significantly larger than those in group C and D. The incidences of flatulence, nausea and vomiting at 1 and 6 h after operation and the incidence of nausea at 24 h after operation were significantly different among the four groups (all P<0.05). The incidences of nausea and vomiting at 1 and 6 h after surgery, gastric distension at 6 h after surgery ［1 h after surgery: 15.0%(9/60) vs 36.7%(22/60), 10.0%(6/60) vs 30.0%(18/60); 6 h after surgery: 10.0%(6/60) vs 51.7%(31/60), 8.3%(5/60) vs 51.7%(31/60)］, and nausea at 24 h after surgery ［6.7%(4/60) vs 26.7%(16/60)］ in Group D were all lower than those in Group A (all P<0.05). Conclusion Dexamethasone combined with intraoperative gastrointestinal decompression can reduce the incidence of nausea and vomiting at 1 and 6 h after Baska laryngeal mask airway positive pressure ventilation, gastric bloating at 6 h after surgery, and nausea at 24 h after surgery.