单髁关节置换前静脉应用地塞米松对置换后患者疼痛及并发症的影响  

Effect of intravenous dexamethasone preoperatively on pain and complications after unicondylar arthroplasty

作　　者：王振恒 王治栋[1] 刘乃澄 陈广东[1] 高懋峰[1] 施卫东[1] 朱若夫[1] Wang Zhenheng;Wang Zhidong;Liu Naicheng;Chen Guangdong;Gao Maofeng;Shi Weidong;Zhu Ruofu(Department of Orthopedics,The First Affiliated Hospital of Soochow University,Suzhou 215006,Jiangsu Province,China)

机构地区：[1]苏州大学附属第一医院骨科,江苏省苏州市215006

出　　处：《中国组织工程研究》2022年第33期5297-5302,共6页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金青年科学基金项目(81802223),项目负责人:王振恒。

摘　　要：背景:目前地塞米松在髋、膝关节置换手术中获得了较为广泛的应用,发挥了减少术后疼痛和恶心呕吐及加速患者康复的作用,但国内外对于术前静脉应用地塞米松对膝关节单髁置换后患者的影响尚未见相关报道。目的:探讨术前静脉应用地塞米松对单髁置换后患者的影响。方法:纳入苏州大学附属第一医院骨科2020年1月至2021年5月收治的膝关节骨性关节炎患者,均接受膝关节单髁置换治疗,按照随机数字表法分2组,试验组(n=35)膝关节单髁置换治疗切皮前静脉注射地塞米松8 mg,对照组(n=34)膝关节单髁置换治疗切皮前静脉注射等量的生理盐水。术前及术后第1,2,3天,评估患者休息与行走时的目测类比评分;记录患者术后对应时间点恶心呕吐发生次数;检测患者术前及术后第1,3天的白细胞计数及C-反应蛋白值;术后随访3个月,记录切口感染、假体周围感染及消化道溃疡出血等并发症发生情况。结果与结论:①试验组患者术后第1,2天行走及术后第1天休息的目测类比评分均低于对照组(P<0.05);②试验组患者术后0-6 h,6-24 h的恶心呕吐发生率低于对照组(P<0.05);③试验组术后第1天的白细胞计数、C-反应蛋白值低于对照组(P<0.05);④术后随访3个月,两组患者均未发现切口感染、假体周围感染及消化道溃疡出血等并发症;⑤结果提示,膝关节单髁置换前静脉注射地塞米松,可有效缓解单髁置换后患者早期疼痛、减少术后恶心呕吐的发生、抑制早期炎症反应,有利于患者康复。BACKGROUND:At present,dexamethasone is widely used in hip and knee arthroplasties to reduce postoperative pain,nausea and vomiting,and speed up the recovery of patients.However,domestic and fo reign studies on the role of dexamethasone in the perioperative period of unicondylar arthro plasty have not been reported.OBJECTIVE:To investigate the effect of intravenous dexamethasone on the perioperative period of unicondylar arthro plasty.METHODS:Sixty-nine knee osteoarthritis patients who underwent primary unicondylar arthroplasty in Department of Orthopedics,The First Affiliated Hospital of Soochow University from January 2020 to May 2021 were randomly divided into two groups.Patients in the trial group(n-3 S)were given dexamethasone8 mg intravenously before skin incision.Patients in the control group(n=34)were given an equal volume of normal saline intravenously.Before surgery and 1,2,and 3 days after surgery,the visual analogue scale scores of the patients at rest and walking were evaluated;the occurrences of nausea and vomiting at the co rresponding time points after the surge ry were reco rded.Before surgery and 1 and 3 days after surgery,leukocyte count and C-reactive protein value were detected.The postoperative follow-up was conducted fo r 3 months to reco rd the presence of complications such as wound infection,joint prosthesis infection,peptic ulcer bleeding and so on.RESULTS AND CONCLUSION:(1)The visual analogue scale scores of pain in the trial group were significantly lower than those in the control group when walking on the 1;and 2;day after the operation and resting on the 1;day after the operation(P<0.05).(2)The incidence of nausea and vomiting at 0-6 and6-24 hours after operation was significantly lower in the trial group than that of the control group(P<0.05).(3)The leukocyte count and C-reactive protein value were significantly lower in the trial group than those of the control group on the 1;postoperative day(P<0.05).(4)The patients in the two groups were followed up for 3 months without complicat

关 键 词：单髁置换 人工关节 地塞米松 糖皮质激素 术后恶心呕吐 术后疼痛 围术期 静脉注射 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学]