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中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2019, Vol. 13 ›› Issue (05) : 530 -535. doi: 10.3877/cma.j.issn.1674-134X.2019.05.003

所属专题： 文献；

临床论著

小剂量地塞米松对全髋关节置换术后功能的影响
黄昌辉1,†(), 武明鑫1   
  1. 1. 516000　惠州市第三人民医院骨科医学中心
  • 收稿日期:2019-01-21 出版日期:2019-10-01
  • 通信作者: 黄昌辉

Effects of low dose dexamethasone on patients of total hip arthroplasty

Changhui Huang1,†(), Mingxin Wu1   

  1. 1. Orthopedics center of the third people’s hospital of Huizhou, Huizhou 516000, China
  • Received:2019-01-21 Published:2019-10-01
  • Corresponding author: Changhui Huang
  • About author:
    Corresponding author: Huang Changhui, Email:
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引用本文：

黄昌辉, 武明鑫. 小剂量地塞米松对全髋关节置换术后功能的影响[J]. 中华关节外科杂志(电子版), 2019, 13(05): 530-535.

Changhui Huang, Mingxin Wu. Effects of low dose dexamethasone on patients of total hip arthroplasty[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2019, 13(05): 530-535.

目的

探讨使用两次小剂量地塞米松对全髋关节置换术后疼痛和康复的临床疗效和安全性。

方法

选取2017年10月至2018年10月惠州市第三人民医院骨科需要行初次THA患者，排除对地塞米松过敏，酒精或药物滥用者，存在风湿免疫系统疾病，手术前7 d给予任何强阿片类药物和其他心肺功能缺陷的患者。共80例THA患者，采用随机数表法，随机分为对照组和实验组，对照组麻醉诱导前静脉注射10 mg地塞米松；实验组在麻醉诱导前和术后12 h接受了两种剂量的10 mg地塞米松。比较C反应蛋白(CRP)、白介素6(IL-6)和视觉模拟疼痛评分(VAS)、术后恶心呕吐(PONV)发生率、术后疲劳程度、髋关节活动度(ROM)、住院时间、镇痛药和止吐消耗量及并发症。采用独立样本t检验比较两组患者围手术期CRP、IL-6、VAS、疲乏程度及ROM等；采用卡方检验比较性别、PONV及并发症。

结果

实验组术后24 h(t ＝－1.259，P<0.05)、48 h(t＝－2.684，P<0.05)、72 h(t＝－3.669，P<0.05)的CRP低于对照组。同样的，实验组术后24 h(t＝－1.954，P<0.05)、48 h(t＝－3.418，P<0.05)、72 h(t＝－4.985，P<0.05)的IL-6水平均低于对照组。实验组术后24 h(t＝－2.647，P<0.05)、48 h(t＝－2.12，P<0.05)、72 h(t＝－1.367，P<0.05)的VAS评分低于对照组。实验组相比对照组术后PONV发生率更低(χ2 ＝1.067，P<0.01)、术后疲劳减轻(t＝－2.154，P<0.01)、镇痛药和止吐药消耗量更少。实验组相比对照组，缩短了住院时间(t＝0.517，P<0.01)，增加了关节活动度(t＝－3.228，P<0.01)。两组均未发生早期手术切口感染或消化道出血。

结论

全髋关节置换术患者应用两次剂量地塞米松，可降低术后CRP、IL-6水平，增加镇痛效果，减少PONV发生率和术后疲劳，但不增加早期手术切口感染和消化道出血的风险。

关键词: 地塞米松, 关节成形术，置换，髋
Objective

To investigate the clinical efficacy and safety of using twice low-dose dexamethasone in the treatment of pain and rehabilitation following total hip arthroplasty (THA).

Methods

From October 2017 to October 2018, patients in the Orthopedics Center of the Third People’s Hospital of Huizhou who needed primary THA were selected. The patients with dexamethasone allergy, alcohol or drug abuse, rheumatic immune system diseases, and the patients who were given any strong opioids or other cardiopulmonary defects 7d before surgery were excluded. A total of 80 THA patients were divided into control group and experimental group by random number table method. The control group received 10 mg dexamethasone intravenously before anesthesia induction and the experimental group received two doses of 10 mg dexamethasone before and 12 h after anesthesia induction. C-reactive protein (CRP), interleukin-6 (IL-6) levels and visual analogue scale (VAS), postoperative incidence of nausea and vomiting (PONV), postoperative fatigue, hip range of motion (ROM), length of stay, analgesics and antiemetic consumption and complications were compared by t test or chi-square test.

Results

The level of CRP in the experimental group was lower than that in the control group in 24 h (t =-1.259, P<0.05), 48h (t=-2.684, P<0.05)and 72 h (t=-3.669, P<0.05)postoperatively. The level of IL-6 in the experimental group was lower than that in the control group in 24 h (t=-1.954, P<0.05), 48h (t=-3.418, P<0.05)and 72 h (t =-4.985, P<0.05)postoperatively. VAS of the experimental group was lower than that of the control group at 24h (t =-2.647, P<0.05), 48 h (t=-2.12, P<0.05)and 72 h (t=-1.367, P<0.05)postoperatively. Compared with the control group, the incidence of PONV was lower(χ2 =1.067, P<0.01), postoperative fatigue was alleviated(t=-2.154, P<0.01), and the consumption of analgesics and antiemetic drugs was less in the experimental group than in the control group. Compared with the control group, the experimental group shortened the length of stay(t=0.517, P<0.01) and increased the ROM(t=-3.228, P<0.01). There was no early operative incision infection or gastrointestinal bleeding in both groups.

Conclusion

Two doses of dexamethasone in patients with THA can decrease the level of CRP, IL-6, increase the analgesic effect, and reduce the incidence of PONV and postoperative fatigue, which would not increase the risk of early surgical incision infection and gastrointestinal bleeding.

Key words: Dexamethasone, Arthroplasty, replacement, hip
表1 两组患者基线资料比较
组别 例数 年龄[岁，(±s)] 性别(男/女) BMI[kg/m2，(±s)] ROM[°，(±s)] ICFS[分，(±s)] 术前血红蛋白[g/L，(±s)] 术前血细胞比容(±s) 高血压(例) 糖尿病(例)
对照组 40 67.3±3.5 15/25 25.7±2.1 94.2±3.2 65.7±10.2 13.4±0.6 39.7±1.2 11 9
实验组 40 66.7±5.0 17/23 25.9±2.1 92.8±3.3 66.2±11.5 13.5±0.5 39.9±1.3 13 12
统计值 ? t＝0.596 χ2＝0.208 t＝－0.924 t＝0.627 t＝－0.339 t＝－0.808 t＝－0.284 χ2＝0.238 χ2＝0.581
P值 ? >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05
图1 两组患者CRP(C反应蛋白)的比较。实验组CRP在术后24、48和72 h要低于对照组(P<0.05)。Pre-术前；Post-术后；*-P<0.05
图2 两组患者IL-6(白介素6)的比较。实验组IL-6在术后24、48和72 h要低于对照组(P<0.05)。Pre-术前；Post-术后；*-P<0.05
图3 两组患者VAS(视觉模拟疼痛评分)的比较。实验组VAS在术后24、48和72 h要低于对照组(P<0.05)。Pre-术前；Post-术后；*-P <0.05
表2 术后两组患者止痛药消耗结果
组别 例数 盐酸羟考酮缓释片 盐酸哌替啶注射液
需要人数(例) 平均消耗量[mg，(±s)] 需要人数(例) 平均消耗量[mg，(±s)]
对照组 40 19 19±6 11 27±7
实验组 40 7 7±3 3 7±4
统计值 － χ2＝0.202 t＝2.961 χ2＝5.541 t＝3.697
P值 － <0.01 <0.01 <0.01 <0.01
表3 术后两组患者止吐药消耗结果
组别 例数 甲氧氯普胺 PONV(例)
需要人数(例) 平均消耗量[mg，(±s)]
对照组 40 18 9.0±1.6 12
实验组 40 8 2.7±1.1 8
统计值 － χ2＝5.698 t＝2.885 χ2＝1.067
P值 － <0.05 <0.01 <0.01
表4 两组患者术后临床效果及并发症
组别 例数 ICFS[分，(±s)] ROM(°，(±s)] 住院时间(d，(±s)] 手术时间(分，(±s)] 并发症(例)
DVT PE 浅表感染 深部感染 胃肠道出血
对照组 40 76.4±9.2 99.9±3.3 5.0±0.6 67.3±3.2 0 0 0 0 0
实验组 40 86.6±8.2 103.8±5.3 4.7±0.9 68.2±3.5 0 0 2 0 0
统计值 － t＝－2.154 t＝－3.228 t＝0.517 t＝－0.426 χ2＝2.051
P值 － <0.01 <0.01 <0.01 >0.05 >0.05
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