| Objectives To observe the effect of single dose of methylprednisolone and dexamethasone on the early prognosis of laparoscopic gynecological surgery and to explore its possible mechanism preliminarily.Methods90 patients who opted for laparoscopic gynecological surgery were numbered according to the order of patient visits,and the random values were calculated in ascending order with the RANDOM of the excel table.1 to 30 cases into the Group M : anesthesia before intravenous infusion of methylprednisolone 40mg;31 to 60 cases into the Group D : pre-induced intravenous infusion of dexamethasone 7.5mg;61 to 90 cases into the Group C(control Group): Pre-intravenous infusion of saline2 ml.Postoperative use of morphine patient-controlled intravenous analgesia(PCIA),no background dose,patients medicate themselves on demand.The VAS score(divided by 3 of the total score of incisional pain,pelvic pain as well as shoulder pain)and 24 h morphine cumulative use were observed and recorded at 2,4,8,12 and 24 hours after operation.Postoperative nausea and vomiting(PONV),Lethargy,respiratory depression,postoperative infection,wound healing,postoperative hospital stay,patient satisfaction,etc.Before and after induction,the blood was taken at 2,24 hours after operation.Blood glucose was measured with blood gas analyzer.The remaining blood samples were placed in sterile,pyrogen-free test tubes.The supernatant was taken after 10mins' centrifuge treatment at 3000r/min.Then it was divided into four 0.5 ml sterile EP tubes,sealed tightly,marked and placed in a-80? freezer to save.IL-6 Concentration was tested after the completion of the samples collections.Finally statistically analysis was made to draw conclusions.Results1.There were no statistical differences in age,BMI,ASA grade and vital signs among the three Groups(P>0.05).2.There were no significant differences statistically in surgical types,operation time,anesthesia time,and intraoperative sufentanil usages among the three Groups(P>0.05).3.The VAS scores of each Group were 0 points before induction of anesthesia,and there was no significant difference statistically among the Groups(P>0.05);The VAS score of Group D was lower than that of Group C at 2,4,8 and 12 h M,the difference was statistically significant(P<0.05);VAS score in each Group was lower than that at other time points after operation,the difference was statistically significant(P<0.05);the difference among Groups was no significant statistically difference(P>0.05);There was no significant difference statistically between Group D and Group M at each time point after surgery(P>0.05).4.The cumulative use of 24 h morphine was 12.35 ± 0.87 mg in Group M,12.40 ±0.70 mg in Group D,20.55 ± 0.89 mg in Group C.M,Group D compared with the Group C,the usage amount were significantly reduced,the difference was statistically significant(P<0.01).The comparison between Group M and D was no significant difference statistically(P>0.05).5.There was no significant difference in IL-6 concentration among the three Groups before induction(P>0.05).Compared to the levels of IL-6 before surgeries,they were significantly increased at 2 and 24 h in each Group after operations,the difference was statistically significant(P<0.01);the levels of IL-6 in Group M and D were lower than Group C at 2 and 24 h after operations,the difference was statistically significant(P<0.01);the level of IL-6 in Group M was lower than in Group D at 2 and 24 h after operations,the difference was statistically meaningful(P<0.05).6.There was no significant difference statistically in blood glucose concentration among the three Groups before induction(P>0.05);compared to the concentration before induction,there was no significant difference statistically 24 hours after surgeries(P>0.05),and the comparison among the Groups was meaningless statistically(P>0.05);Blood glucose in patients was increased in 2h after operations,the difference was statistically significant among the Groups(P<0.05),the comparison among the Groups was no meaning statistically(P>0.05).7.PONV incidence in laparoscopic gynecological surgery was high,Group C nausea in 10 cases,vomiting in 4 cases,the total proportion up to 46.7%,Group M group nausea in 6 cases,vomiting in 1 case,Group D nausea did not in 3 cases,vomiting 2 cases;There was significant difference statistically in the total proportion of Group M and Group D comparing with Group C(P<0.05),the comparison between Group M and Group D was meaningless statistically(P>0.05).8.There were no averse reactions like lethargy and respiratory depression and others after surgeries among the three Groups,no wound infections were found,all of patients were Grade A healing;There was no statistically significant difference in postoperative hospital stays(P>0.05).9.The satisfaction rate of the three groups was 90% in M group,86.7% in group D,76.7% in group C,the comparison among the three Groups was different statistically(P<0.05).Conclusions Methylprednisolone 40 mg or dexamethasone 7.5mg to be given before anesthesia induction can reduce the pain of patients who were taken laparoscopic gynecological surgery within 12 h,and opioid analgesic drug dose can be reduced24 hs after surgeries;and it can inhibit the inflammatory response,reduce the occurrence of PONV;also it can improve patient satisfaction,no postoperative infection and other adverse reactions could be found. |
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