中国组织工程研究 ›› 2017, Vol. 21 ›› Issue (3): 335-339.doi: 10.3969/j.issn.2095-4344.2017.03.002

• 人工假体 artificial prosthesis • 上一篇    下一篇

膝关节置换应用甲基泼尼松龙对术后恶心呕吐和疼痛的影响及安全性评估

田海涛,王远贺,田少奇,张旭腾,孙 康   

  1. 青岛大学医学院附属医院关节外科,山东省青岛市 266003
  • 修回日期:2016-11-29 出版日期:2017-01-28 发布日期:2017-03-14
  • 通讯作者: 孙康,主任医师,博士生导师,青岛大学医学院附属医院骨科,山东省青岛市 266003
  • 作者简介:田海涛,男,1989年生,山东省潍坊市人,汉族,青岛大学医学院在读硕士,主要从事膝、髋关节置换方面的研究。

Effects and safety assessment of methylprednisolone on postoperative nausea and vomiting and pain after total knee arthroplasty

Tian Hai-tao, Wang Yuan-he, Tian Shao-qi, Zhang Xu-teng, Sun Kang   

  1. Department of Orthopedics, Affiliated Hospital of Qingdao University Medical College, Qingdao 266003, Shandong Province, China
  • Revised:2016-11-29 Online:2017-01-28 Published:2017-03-14
  • Contact: Sun Kang, Chief physician, Doctoral supervisor, Department of Orthopedics, Affiliated Hospital of Qingdao University Medical College, Qingdao 266003, Shandong Province, China
  • About author:Tian Hai-tao, Studying for master’s degree, Department of Orthopedics, Affiliated Hospital of Qingdao University Medical College, Qingdao 266003, Shandong Province, China

摘要:

文章快速阅读:

 

文题释义:
甲基泼尼松龙:是一种人工合成的新型中效糖皮质激素,具有糖皮质激素的作用,其盐皮质激素样作用较氢化泼尼松弱,而抗炎镇吐作用较强,现已有报道应用于髋、膝关节置换手术中。
人工膝关节置换术后恶心呕吐:发生率较高,研究发现,甲基泼尼松龙可有效减少术后恶心呕吐的发生,在促进患者术后快速康复方面具有重要意义,且不增加术后感染等不良反应的风险,其应用具有较高的有效性及安全性。国内外较多的研究地塞米松对膝关节置换后的影响,对于甲基泼尼松龙应用于膝关节置换的研究相对较少。
 
摘要
背景:目前地塞米松已普遍应用到骨科大手术围手术期中,用于减少术后疼痛及恶心呕吐发生,但国内对于甲基泼尼松龙减少单侧全膝关节置换后恶心呕吐和疼痛的研究报道较少。
目的:探讨单侧全膝关节置换围手术期应用甲基泼尼松龙对于术后恶心呕吐和疼痛的影响及安全性评估。
方法:单侧膝关节置换的患者共86例,随机分为2组:甲基泼尼松龙组患者置换中及置换后24 h内分别给予甲基泼尼松龙40 mg静脉滴注;对照组相应时间给予等量生理盐水静滴。观察记录两组患者术后0-6 h,6-24 h,24-48 h,48-72 h 4个不同时间段的术后恶心呕吐发生次数及置换后0-72 h总发生率,记录置换后6,24,48,72 h膝关节目测疼痛目测类比评分及置换后第3天的膝关节功能评分,检测 C-反应蛋白值及空腹血糖。随访6个月复查并记录2组患者置换后不良反应发生情况。
结果与结论:①甲基泼尼松龙组患者置换后0-72 h总的术后恶心呕吐发生率及置换后6,24 h的恶心呕吐发生率均显著低于对照组(P < 0.05);②甲基泼尼松龙组置换后6,24 h疼痛评分(VAS)均显著低于对照组(P < 0.05);③置换后甲基泼尼松龙组的膝关节活动度KSS评分显著高于对照组(P < 0.05);④2组患者置换前后的C-反应蛋白、血糖差异无显著性意义(P > 0.05);⑤2组患者术后术后随访3月发现手术切口均一期愈合,均未发生术后感染等并发症。⑥结果表明,单侧全膝关节置换围手术期应用甲基泼尼松龙能够明显减少术后恶心呕吐和疼痛,同时不增加置换后感染等并发症的发生。

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程
ORCID:
0000-0001-8906-9642(田海涛)

关键词: 骨科植入物, 人工关节, 全膝关节置换, 人工假体, 甲基泼尼松龙, 糖皮质激素, 术后恶心呕吐, 术后疼痛, 快速康复

Abstract:

BACKGROUND: At present, dexamethasone has been widely used in the perioperative period of major surgery in the orthopedics for reducing postoperative pain and nausea and vomiting, but the study on the application of methylprednisolone to reducing postoperative nausea and vomiting and pain after unilateral total knee

arthroplasty is rarely reported.
OBJECTIVE: To evaluate the effects and safety assessment of the application of methylprednisolone on postoperative nausea and vomiting and pain after unilateral total knee arthroplasty.
METHODS: A total of 86 patients undergoing unilateral total knee arthroplasty were randomly assigned to two groups. Patients in the methylprednisolone group were given methylprednisolone 40 mg in intravenous drip within 24 hours during and after replacement. Patients in the control group were given an equal volume of saline in intravenous drip at the same time. The incidence of postoperative nausea and vomiting was observed and recorded at 0-6 hours, 6-24 hours, 24-48 hours, and 48-72 hours after surgery, as well as the total incidence was recorded in both groups. Pain visual analogue scale (VAS) score at 6, 24, 48 and 72 hours after replacement, and knee joint scoring system (KSS) score at 3 days after replacement were recorded. C-reactive protein and fasting blood glucose were determined. The occurrence of adverse reactions postoperatively was recorded in 6-month follow-up in both groups.
RESULTS AND CONCLUSION: (1) The total incidence rate of postoperative nausea and vomiting during 0-72 hours after surgery, and incidence rates of nausea and vomiting at 6 and 24 hours were significantly lower in the methylprednisolone group than in the control group (P < 0.05). (2) Pain VAS score was significantly lower in the methylprednisolone group than in the control group at 6 and 24 hours after surgery (P < 0.05). (3) KSS scores were significantly higher in the methylprednisolone group than in the control group after surgery (P < 0.05). (4) C-reactive protein and fasting blood glucose were not significantly different between two groups before and after surgery (P > 0.05). (5) The surgical incision was found to heal in 3-month follow-up and no postoperative infection occurred in both groups. (6) Results show that methylprednisolone can obviously reduce postoperative nausea and vomiting and pain in unilateral total knee arthroplasty, and did not increase the incidence of postoperative infection. 

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程

Key words: Arthroplasty, Replacement, Methylprednisolone, Nausea, Vomiting, Pain, Tissue Engineering

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