利多卡因联合地塞米松对甲状腺手术患者术后恶心呕吐的影响

Effect of Lidocaine Combined with Dexamethasone on Postoperative Nausea and Vomiting in Patients Undergoing Thyroid Surgery

摘要: 目的：探讨利多卡因联合地塞米松对甲状腺手术患者术后恶心呕吐(Postoperative Nausea and Vomiting, PONV)的影响。方法：选择2023年9月~2024年8月在右江民族医学院附属医院住院并择期行单侧甲状腺次全切除术的女性患者120例，随机分为L (利多卡因)组、D (地塞米松)组、LD (利多卡因联合地塞米松)组和N (生理盐水)组四组，每组30例。对比四组术后T₁ (0~2 h)、T₂ (2~6 h)、T₃ (6~12 h)、T₄ (12~24 h)时间段PONV发生情况和术后24 h内PONV的级别；患者一般情况、麻醉时间、手术时间和输液量；术后2 h、6 h、12 h和24 h的静息VAS疼痛评分；入室时(t₀)、气管插管时(t₁)及拔除气管导管时(t₂)的平均动脉压(MAP)和心率(HR)；术中阿片类药物用量、术后首次排气时间、术后24 h氟比洛芬酯(凯纷)补救镇痛和补救止吐胃复安的例数及患者总体满意率；围术期发生的不良反应。结果：四组患者在年龄、BMI、麻醉时间和输液量等一般资料比较上，无统计学差异(P > 0.05)；与其他三组相比，LD组术后24 h内的恶心和呕吐程度最低(P < 0.05)，与N组相比，L组和D组术后24 h内的恶心和呕吐的程度显著低(P < 0.05)，L组和D组术后24 h内恶心和呕吐程度之间的差异无统计学意义(P > 0.05)；在T₁、T₂、T₃和T₄各时间段，与其他三组相比，LD组恶心发生率明显降低(P < 0.05)，与N组相比，L组和D组恶心和呕吐发生率明显降低，LD组呕吐发生率明显降低，差异均有统计学意义(P < 0.05)；在T₁、T₂和T₃各时间段，与L组和D组相比，LD组呕吐发生率明显降低(P < 0.05)，在各时段，L组和D组恶心和呕吐发生率之间的差异无统计学意义(P > 0.05)；与其他三组相比，LD组术后2 h、6 h、12 h和24 h VAS评分最低(P < 0.05)，与N组相比，L组和D组术后各时间点的VAS评分显著降低(P < 0.05)，L组和D组术后各时间点的VAS评分之间的差异无统计学意义(P > 0.05)；组间比较：t₀时刻，四组患者MAP和HR之间的差异无统计学意义(P > 0.05)；在t₁、t₂时刻，与其他三组相比，LD组的MAP和HR显著低(P < 0.05)，与N组相比，L组和D组的MAP和HR显著低(P < 0.05)，L组和D组的MAP和HR之间的差异无统计学意义(P > 0.05)；组内比较：与t₀时刻比，N组在t₁和t₂时刻的MAP、HR明显增高(P < 0.05)；L组、D组和LD组在t₁和t₂时刻的MAP、HR与t₀时刻之间的差异无统计学意义(P > 0.05)；舒芬太尼用量在各组之间的差异无统计学意义(P > 0.05)，与其他三组相比，LD组的瑞芬太尼用量最少、术后首次排气时间缩短、补救镇痛和止吐的例数最少及总体满意率最高(P < 0.05)；与N组相比，L组和D组瑞芬太尼用量少、术后首次排气时间缩短、补救镇痛和止吐的例数少及总体满意率高(P > 0.05)，L组和D组的瑞芬太尼用量和术后各指标之间的差异无统计学意义(P > 0.05)；各组不良反应发生率之间的差异无统计学意义(P > 0.05)。结论：1) 利多卡因联合地塞米松能显著降低甲状腺手术患者PONV的发生率。2) 利多卡因联合地塞米松能增强术后镇痛效果，增加血流动力学的稳定性，减少补救镇痛和止吐药物的使用，促进术后康复。

Abstract: Objective: To investigate the effects of lidocaine combined with dexamethasone on postoperative nausea and vomiting (PONV) in patients undergoing thyroid surgery. Methods: A total of 120 female patients hospitalized in the Affiliated Hospital of Youjiang Medical University for Nationalities from September 2023 to August 2024 who underwent unilateral subtotal thyroidectomy were selected and randomly divided into four groups: L (lidocaine) group, D (dexamethasone) group, LD (lidocaine combined with dexamethasone) group and N (normal saline) group, with 30 cases in each group. We compared the occurrence of PONV at T₁ (0~2 h), T₂ (2~6 h), T₃ (6~12 h), and T₄ (12~24 h) and the grade of PONV within 24 h after surgery among the four groups; patient’s general condition, anesthesia time, operation time and infusion volume; resting VAS pain scores at 2 h, 6 h, 12 h and 24 h after surgery; Mean Arterial Pressure (MAP) and Heart Rate (HR) at entry (t₀), tracheal intubation (t₁), and tracheal catheter removal (t₂); intraoperative opioid dosage, the first postoperative exhaust time, the number of cases of flurbiprofen axetil (Kefon) for analgesia and metoclopramide for emetic relief 24 h after surgery, and the overall satisfaction rate of patients; adverse reactions occurred during perioperative period. Results: There were no significant differences in age, BMI, anesthesia time and infusion volume among the four groups (P > 0.05). Compared with the other three groups, LD group had the lowest degree of nausea and vomiting within 24 h after surgery (P < 0.05); compared with N group, the degree of nausea and vomiting within 24 h after surgery in L and D groups was significantly lower (P < 0.05); there was no statistical significance between L and D groups in the degree of nausea and vomiting within 24 h after surgery (P > 0.05). In each time period of T₁, T₂, T₃ and T₄, the incidence of nausea in LD group was significantly decreased compared with the other three groups (P < 0.05); compared with group N, the incidence of nausea and vomiting in groups L and D was significantly decreased, and the incidence of vomiting in LD group was significantly decreased, with statistical significance (P < 0.05). In T₁, T₂ and T₃ time periods, the incidence of vomiting in LD group was significantly lower than that in L and D groups (P < 0.05), and there was no statistical significance in the incidence of nausea and vomiting between L and D groups (P > 0.05). Compared with the other three groups, the LD group had the lowest VAS scores at 2 h, 6 h, 12 h and 24 h after surgery (P < 0.05); compared with the N group, the VAS scores of the L and D groups were significantly decreased at each time point after surgery (P < 0.05); there was no statistical significance between the L and D groups at each time point after surgery (P > 0.05). Inter-group comparison: at t₀, there was no significant difference in MAP and HR among the four groups (P > 0.05). At t₁ and t₂, compared with the other three groups, MAP and HR in LD group were significantly lower (P < 0.05), compared with group N, MAP and HR in L and D groups were significantly lower (P < 0.05), and there was no statistically significant difference between MAP and HR in L and D groups (P > 0.05). Intra-group comparison: Compared with t₀ moment, MAP and HR in group N were significantly increased at t₁ and t₂ moments (P < 0.05). There was no significant difference between MAP, HR and t₀ in L, D and LD groups at t₁ and t₂ (P > 0.05). There was no statistically significant difference in the dosage of sufentanil among all groups (P > 0.05). Compared with the other three groups, the dosage of remifentanil in LD group was the least, the first postoperative exhaust time was shortened, the number of cases of relief analgesia and antiemetics was the least, and the overall satisfaction rate was the highest (P < 0.05). Compared with group N, the dosage of remifentanil in groups L and D was lower, the first postoperative exhaust time was shorter, the number of cases of relief analgesia and antiemea was lower, and the overall satisfaction rate was higher (P > 0.05). There was no statistically significant difference between the dosage of remifentanil and postoperative indexes in groups L and D (P > 0.05). There was no significant difference in the incidence of adverse reactions among all groups (P > 0.05). Conclusion: 1) Lidocaine combined with dexamethasone can significantly reduce the incidence of PONV in patients undergoing thyroid surgery. 2) Lidocaine combined with dexamethasone can enhance postoperative analgesia, increase hemodynamic stability, reduce the use of remedial analgesia and antiemetic drugs, and promote postoperative rehabilitation.