[目的]探究甲强龙与地塞米松对全膝关节置换术围术期加速康复的影响分析。[方法]选取2016年11月~2017年11月于本院行膝关节置换96例患者为研究对象,采用随机数字表法将其分为三组,其中D组应用地塞米松,M组应用等效价的甲强龙,N组应用等量生理盐水。观察比较各组手术情况及术后不同时间段恶心呕吐发生率、疼痛和疲倦程度、镇痛药物使用情况、血液生化指标及术后并发症等情况。[结果]三组患者切口长度、手术时间、术中出血量、术后引流量以及住院时间比较差异无统计学意义(P>0.05),但是D组和M组术后曲马多使用量明显少于N组(P<0.05)。D组和M组术后0~6 h和6~24 h恶心呕吐发生率明显低于N组(P<0.05)。D组和M组术后第1 d和术后第3 d患肢肿胀率明显低于N组(P<0.05)。D组和M组术后24、48 h时的疼痛和疲倦评分均低于N组(P<0.05)。D组和M组术后第1 d时的白细胞计数明显低于N组、血糖明显高于N组(P<0.05)。但是,D组和M组间上述各指标差异均无统计学意义(P>0.05)。[结论] TKA术前静脉应用甲强龙(40 mg)或地塞米松(8 mg)均可有效降低术后恶心呕吐发生、缓解术后早期疼痛和疲倦程度,抑制早期炎症反应,减少镇痛药物应用,安全有效,两者疗效无明显差异。
[Objective] To explore the effect of methylprednisolone and dexamethasone on perioperative condition of total knee arthroplasty(TKA).[Method] Ninety-six patients who underwent knee arthroplasty in our hospital from November 2016 to November 2017 were selected as the study subjects. They were divided into three groups by random number table method.Group D was treated with dexamethasone, group M was treated with methylprednisolone, and group N was treated with saline.The incidence of nausea and vomiting, the degree of pain and fatigue, the use of analgesics, blood biochemical parameters and postoperative complications were observed and compared among the 3 groups.[Results] There were no significant differences regarding to incision length, operation time, intraoperative bleeding volume, postoperative drainage and hospital stay among the 3 groups(P>0.05), nevertheless the usage of tramadol in the Group D and Group M was significantly less than that in the Group N(P<0.05). There was no significant difference in the incidence of postoperative complications among them(P>0.05). The Group D and Group M proved significantly superior to the Group N regarding to nausea and vomiting perioperatively(P<0.05), swelling rate of affected limbs in at the first day and the third day after operation(P<0.05), VAS and fatigue scores at 24 and 48 hours after operation(P<0.05) and white blood cell count(P<0.05), although the former two group had significantly higher blood sugar than the latter one group(P<0.05). However, there was no significant difference in anyone of foresaid parameters between the Group D and Group M(P>0.05).[Conclusion] Intravenous administration of methylprednisolone(40 mg) or dexamethasone(8 mg) perioperatively does effectively reduce the use of analgesics, reduce the occurrence of nausea and vomiting, relieve pain and fatigue, as well as inhibit early inflammatory reaction after TKA. There is no significant difference in the efficacy between the two drugs.
The Orthopedic Journal of China
total knee arthroplasty
王亚飞,硕士研究生在读,研究方向:骨与关节修复与重建,(电话)13199451782,(电子信箱)wangyafeiguke@ 163.com;通信作者:廉永云,(电子信箱)liandadong@ 163.com.