术前单次高剂量静脉滴注甲泼尼龙在全关节置换术后疼痛管理中的有效性和安全性的meta分析  

Efficacy and safety of preoperative intravenous methylprednisolone administration for pain management after total joint replacement:a meta-analysis

作　　者：何舰 叶斯哈提·木拉提别克 贺海艳 郭万首[2] HE Jian;Yesihati·Mulatibieke;HE Haiyan;GUO Wanshou(Graduate School,Beijing University of Chinese Medicine,Beijing 100105,China;Department of Orthopedics,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]北京中医药大学研究生院,北京100105 [2]中日友好医院骨科,北京100029

出　　处：《中华骨与关节外科杂志》2024年第6期533-542,共10页Chinese Journal of Bone and Joint Surgery

摘　　要：目的:通过meta分析评价术前单次高剂量静脉滴注甲泼尼龙(MP)在全关节置换术后疼痛管理中的有效性和安全性。方法:检索Pubmed、Embase、Cochrane Library、Web of Science共4个数据库中关于全关节置换术前单次高剂量静脉滴注MP的随机对照试验(RCT)研究,时间范围为从建库开始至2023年12月。运用RevMan 5.3软件进行meta分析。结果:共检索到文献904篇,筛选后最终纳入8篇文献进行meta分析,共包括583例患者。分析结果显示:MP组患者术后6 h疼痛视觉模拟(VAS)评分及术后24 h静息状态VAS评分均显著低于对照组患者[术后6 h:平均差(MD)=-2.66,95%置信区间(95%CI):-4.63~-0.69,P=0.008;术后24 h静息状态:MD=-0.91,95%CI:-1.56~-0.25,P=0.006],术后24 h、48 h VAS评分与对照组患者相比差异均无统计学意义(术后24 h:MD=-0.40,95%CI:-2.34~1.54,P=0.680;术后48 h:MD=-0.46,95%CI:-1.40~0.48,P=0.340);MP组患者术后阿片类药物使用率显著低于对照组患者(OR=0.12,95%CI:0.03~0.43,P=0.001);MP组患者术后恶心发生率显著低于对照组患者[比值比(OR)=0.08,95%CI:0.01~0.43,P=0.004],术后24 h、48 h呕吐发生率均低于对照组患者,且术后48 h呕吐发生率差异有统计学意义(术后24 h:OR=0.58,95%CI:0.18~1.93,P=0.370;术后48 h:OR=0.13,95%CI:0.02~0.78,P=0.030);MP组患者昂丹司琼使用率也显著低于对照组患者(OR=0.18,95%CI:0.05~0.61,P=0.006);MP组患者住院时间显著短于对照组患者(MD=-1.01,95%CI:-1.99~-0.03,P=0.040);MP组患者术后0 h、24 h、48 h、72 h C反应蛋白(CRP)水平均显著低于对照组患者(术后0 h:MD=-15.08,95%CI:-27.83~-2.32,P=0.020;术后24 h:MD=-22.13,95%CI:-32.77~-11.50,P<0.001;术后48 h:MD=-59.25,95%CI:-78.44~-40.05,P<0.001;术后72 h:MD=-53.70,95%CI:-77.33~-30.07,P<0.001)。MP组与对照组患者术后并发症发生率差异无统计学意义(OR=0.59,95%CI:0.08~4.61,P=0.610)。结论:术前单次高剂量静脉滴注MP可以有效减轻全关节置换术后疼痛,减少术后恶心呕吐和�Objective:To evaluate the efficacy and safety of preoperative single high-dose intravenous methylprednisolone(MP) for pain management in total joint arthroplasty(TJA).Methods:The Pubmed,Embase,Cochrane Library,and Web of Science databases were searched for randomized controlled trials(RCTs) involving a single intravenous dose of MP before TJA,from the inception of the database to December 2023.The meta-analysis was performed using RevMan 5.3 software.Results:A total of 904 articles were retrieved,and 8 articles involving 583 patients were finally included in the meta-analysis after screening.The analysis results showed that the postoperative 6-hour visual analogue scale(VAS) scores and the 24-hour resting VAS scores in the MP group were significantly lower than those in the control group(postoperative 6 hours:mean difference [MD]=-2.66,95% confidence interval [95%CI],-4.63 to-0.69,P=0.008;24-hour resting:MD=-0.91,95%CI,-1.56 to-0.25,P=0.006).There was no statistically significant difference in the control group in the VAS socres at 24 hours or 48 hours postoperatively(24 hours:MD=-0.40,95%CI,-2.34 to 1.54,P=0.680;48hours:MD=-0.46,95%CI,-1.40 to 0.48,P=0.340).The opioid use rate in the MP group was significantly lower than that in the control group(OR=0.12,95%CI,0.03 to 0.43,P=0.001);the incidence of postoperative nausea in the MP group was significantly lower than that in the control group(OR=0.08,95%CI,0.01 to 0.43,P=0.004),the incidence of vomiting was statistically lower than that of the control group at 24 hours and 48 hours postoperatively and was significantly lower at 48 hours postoperatively(24 hours:OR=0.58,95%CI,0.18 to 1.93,P=0.370;48 hours:OR=0.13,95%CI,0.02 to 0.78,P=0.030);the postoperative ondansetron usage rate in the MP group was also significantly lower than that in the control group(OR=0.18,95%CI,0.05 to 0.61,P=0.006);hospital stay in the MP group was significantly shorter than that in the control group(MD=-1.01,95%CI,-1.99 to-0.03,P=0.040);and the C-reactive protein levels of patients in the M

关 键 词：甲泼尼龙 全关节置换术 疼痛管理 META分析 

分 类 号：R684[医药卫生—骨科学]