摘要
目的探讨小剂量糖皮质激素在高龄关节置换患者围手术期应用的安全性和有效性。方法选择我科75岁以上择期关节置换手术患者78例，随机分为地塞米松组（A组）和对照组（s组）各39例。术中给予A组地塞米松10mg，术后第1、2、3天每天给予5mg静脉推注，给予S组术中生理盐水10mg，术后第1、2、3天分别给予5mg静脉推注。观察患者术后体温、疼痛评分等指标并进行统计学分析。结果两组共78例患者无一例出现感染，均在术后14d拆线后顺利出院，其中地塞米松组术后第1、3天疼痛评分（均值为2．744、1．769）明显小于对照组（均值为3．385、2．308，P〈0．01），术后第3天与术前1d体温波动值小于对照组（P〈0．01）。地塞米松组与对照组术后第3天与术前第1天血清白蛋白（P〉0．05）、空腹血糖波动值差异无统计学意义（P〉0．05）。地塞米松组术后第3天（膝）关节活动度膝关节评分系统（HSS）评分（P〈0．01）及髋关节Harris评分（P〈0．05）明显高于对照组。实验组术后的食欲及精神状态明显好于对照组。结论高龄关节置换患者围手术期应用小剂量糖皮质激素，可显著降低不良事件发生率，提高围手术期安全性，并未增加应用糖皮质激素并发症。
Objective To evaluate the efficacy and safety of low dose glucocorticoid during surgery of joint replacement in old patients. Methods 78 cases patients aged over than 78 years old were random- ly divided into the dexamethasone group （group A, n = 39） and control group （group S, n = 39）. All ca- ses were accepted operation of joint replacement. Group A were given dexamethasone 10 mg in intraopera- tire, extra 5 mg per day was given on 1,2, 3 day after operation. Group S were give 10 ml saline in intra- operative, 5 ml per day were given on 1, 2, 3 day postoperatively. Temperature, pain score, knee joint scoring system （HSS） score, Harris score and the change of serum albumin were evaluated. Results All 78 patients were discharged on 14 days after surgery without any infection cases. Pain score in group A was 2. 7 on the first day and 1.8 on the third day, which was significant lower than group S either on the first day （ 3. 385 ） or the third day （2. 308,P 〈 0.01 ）. The temperature in group A was stable compared with group S on the first day or the third day （P 〈 0. 01 ）. There was no difference between two groups on the third day after operation in serum albumin （ P 〉 0. 05 ） and levels of fasting blood glucose （ P 〉 0.05 ）. HSS score （P 〈 0.05 ） and Harris hip score （P 〈 0. 05） were much better in group A than in group S on the third day postoperatively. Conclusion Application of low - dose glucocorticoids is safe in joint re- placement patients preoperatively. It can significantly reduce pain and improve activity without any more complications like infection.
出处
《中华实验外科杂志》
CAS
CSCD
北大核心
2015年第10期2593-2595,共3页
Chinese Journal of Experimental Surgery
关键词
关节置换
糖皮质激素
高龄
Joint replacement
Glucocorticoids
Elderly patients
