应用单次剂量地塞米松可减轻全髋置换术后的运动疼痛  

作　　者：Kenneth J. Kardash Frederic Sarrazin Michael J. Tessler Aria M. Velly 吴进(译) 

机构地区：[1]Department of Anesthesia , Sir Mortimer B Davis-Jewish General Hospital, McGill University, Montreal, Canada [2]Department of Center of Clinical Epidemiology and Community Studies, Sir Mortimer B Davis-Jewish General Hospital, McGill University, Montreal, Canada [3]Department of Diagnostic and Biological Sciences, University of Minnesota, Minneapolis, Minnesota [4]不详

出　　处：《麻醉与镇痛》2009年第3期57-62,共6页Anesthesia & Analgesia

摘　　要：背景手术前应用糖皮质激素可以减少手术后恶心，同时也能提高镇痛效果并减少阿片类药物的用量。方法选择50例连续择期脊麻辅助丙泊酚镇静下行初次单侧全髋关节置换术（THA）的患者，手术开始前以随机、双盲、安慰剂对照的方式静脉输注40mg地塞米松或生理盐水。手术后48小时持续使用吗啡静脉自控镇痛，并每6小时口服布洛芬400mg和对乙酰氨基酚650mg。每4小时记录1次静息疼痛评分（0～10数字评分，NRS）、不良反应和患者自控镇痛吗啡的累积使用量，共48小时。在手术后第24小时记录活动时的NRS评分。在手术后第48小时测量25例患者亚组的C-反应蛋白水平。结果地塞米松组手术中对丙泊酚镇静的需求量明显比对照组增加（234．6±160．1VS138．8±122．7mg，P=0．02）。与对照组相比，地塞米松组手术后的运动痛明显减轻（NRS评分：2．7，95％CI：2．2～3．1和6．8，95％CI：6．4～7．2；P〈0．0001）。地塞米松对任何时点的静息疼痛或者累积的吗啡使用量没有显著影响。地塞米松可以显著减少手术后48小时时C一反应蛋白的水平（52．4mg／L，95％CI：28．2。76．6vs 194．2mg／ml，95％CI：168．9—219．4；P〈0．0001）。对照组有7例患者因恶心需要处理，而地塞米松组仅有1例患者需要处理（P=0．05）。结论全髋关节置换术术前静脉给予单次剂量的地塞米松40mg能持续抑制炎性反应，减轻术后24小时的运动痛。BACKGROUND： Preoperative glucocorticoids reduce postoperative nausea but may also improve analgesia and decrease opioid consumption. METHODS： Fifty consecutive patients undergoing elective, unilateral, primary total hip arthroplasty under spinal anesthesia with propofol sedation received in a randomized, double-blind, placebo-controlled manner either 40 mg of dexamethasone or saline placebo IV before the start of surgery. IV patient-controlled analgesia morphine, ibuprofen 400 mg po q6 h and acetaminophen 650 mg po q6 h were given for 48 h. Pain （0 - 10 numeric rating scale, NRS） at rest, side effects, and total cumulative patient-controlled analgesia morphine consumption were recorded q4 h for 48 h. Dynamic pain NRS score was recorded at 24 h. C-reactive protein levels were measured in a subgroup of 25 patients at 48 h. RESULTS： The intraoperative sedation requirement with propofol was significantly increased in the dexamethasone group （234.6 ± 160. 1 vs 138.8 ±122.7 mg, P =0. 02）. Dynamic pain was greatly reduced in the dexamethasone group （NRS score： 2.7, 95% CI： 2.2 -3.1 vs 6. 8, 6.4 - 7.2; P 〈0. 0001 ）. There was no significant effect on pain at rest or cumulative morphine consumption at any time. C-reactive protein levels at 48 h were markedly reduced by dexamethasone （52.4 mg/ml, 28.2 - 76. 6 vs 194.2,168.9 -219.4; P 〈0. 0001 ）. Seven patients in the control group, but only one in the dexamethasone group, were treated for nausea （P = 0.05）. CONCLUSIONS： A single, preoperative IV dose of dexamethasone 40 mg has a prolonged suppressive effect on the inflammatory response and decreases dynamic pain 24 h after total hip arthroplasty.

关 键 词：地塞米松 疼痛评分 单次剂量 全髋置换术 运动 减轻 吗啡静脉自控镇痛 全髋关节置换术 

分 类 号：R977.11[医药卫生—药品] R5[医药卫生—药学]