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解放军总医院医学创新研究部、国家老年疾病临床医学研究中心(解放军总医院)、解放军总医院第六医学中心心血管病医学部
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中华老年多器官疾病杂志编辑委员会
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创刊人 王士雯
总编辑 范利
副总编辑 陈韵岱
执行主编 叶大训
编辑部主任 王雪萍
ISSN 1671-5403
CN 11-4786
创刊时间 2002年
出版周期 月刊
邮发代号 82-408
友情链接
徐成,曹文姝,周全红,单宇.预防性中等剂量地塞米松对高龄患者膝关节置换术后恶心呕吐及疼痛的影响[J].中华老年多器官疾病杂志,2022,21(8):567~571
预防性中等剂量地塞米松对高龄患者膝关节置换术后恶心呕吐及疼痛的影响
Effect of prophylactic moderate doses of dexamethasone on nausea and vomiting, and pain after knee arthroplasty in elderly patients
投稿时间:2022-01-16  
DOI:10.11915/j.issn.1671-5403.2022.08.122
中文关键词:  老年人  地塞米松  术后恶心呕吐  疼痛  全膝关节置换术
英文关键词:aged  dexamethasone  postoperative nausea and vomiting  pain  total knee arthroplasty This work was supported by the National Natural Science Foundation of China
基金项目:国家自然科学基金面上项目(81771933) 徐成,曹文姝,为共同第一作者
作者单位E-mail
徐成 上海交通大学附属第六人民医院麻醉科,上海 200233 shanyu800302@126.comeffect 
曹文姝 上海市徐汇区田林街道卫生服务中心全科康复病区,上海 200233 shanyu800302@126.comeffect 
周全红 上海交通大学附属第六人民医院麻醉科,上海 200233 shanyu800302@126.comeffect 
单宇 上海交通大学附属第六人民医院麻醉科,上海 200233 shanyu800302@126.comeffect 
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中文摘要:
      目的 探讨围术期静脉注射中等剂量地塞米松对高龄患者膝关节置换术后恶心呕吐和疼痛的预防性作用。方法 本研究为前瞻性、随机、对照试验。选择2021年1月至5月上海交通大学附属第六人民医院关节外科组收治的160例美国麻醉医师协会(ASA)分级Ⅰ级或Ⅱ级,拟行全麻下全膝关节置换的患者为研究对象。将患者随机分为地塞米松组(80例)和生理盐水组(80例),全麻诱导前20min分别注射2ml地塞米松(10mg)(地塞米松组)或2ml生理盐水(生理盐水组),其中6例患者手术时间超过200min,予以剔除,最终地塞米松组有78例患者,生理盐水组有76例患者纳入统计分析。主要观察指标为术后4、12、24、36h的视觉模拟评分法(VAS)评分及口头评分量表(VRS)评分;次要观察指标为止痛药和止吐剂的使用情况、血糖水平、住院天数和术后30d感染率。采用SPSS 21.0统计软件进行数据分析。根据数据类型,分别采用方差分析、t检验、χ2检验或Fisher确切概率法进行组间比较。结果 膝关节置换术后恶心呕吐和疼痛多发生于24h以内,地塞米松组术后4、12、24h的VRS评分、术后恶心呕吐(PONV)发生率及VAS评分明显低于生理盐水组,差异均有统计学意义(P<0.05);术后36h,2组患者VRS评分、PONV发生率及VAS评分比较,差异无统计学意义(P>0.05)。术后第1天地塞米松组血糖水平明显高于生理盐水组[(8.5±1.7)mmol/L和(5.9±1.4)mmol/L,P<0.05];术后第3天2组患者血糖水平比较,差异无统计学意义(P>0.05)。2组患者平均住院天数比较,地塞米松组明显少于生理盐水组[(3.0±0.8)d和(4.8±1.5d)],差异有统计学意义(P<0.05)。2组患者30d内感染率比较,差异无统计学意义(P>0.05)。结论 术前预防性静脉注射10mg地塞米松可有效缓解高龄老年患者全膝关节置换术后恶心呕吐的严重程度和发生率,并显著减轻术后疼痛,同时减少术后镇痛药和止吐药的使用率,并缩短住院天数。
英文摘要:
      Objective To evaluate the prophylactic effect of perioperative use of moderate-dose intravenous dexamethasone on postoperative nausea and vomiting, and pain after total knee arthroplasty in the elderly patients. Methods This study, a prospective, randomized, controlled trial, selected a total of 160 patients of American Society of Anesthesiologists (ASA) grade Ⅰ or Ⅱ, who were admitted to the Joint Surgery Department of the Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University from January to May 2021 and scheduled for total knee arthroplasty under general anesthesia. They were randomly divided into dexamethasone group (n=80) and saline group (n=80). Intravenously, 2 ml dexamethasone (10 mg) or 2 ml saline was injected 20 min before the induction of general anesthesia. Six patients whose operation exceeded 200 min were excluded, leaving 78 cases in the dexamethasone group and 76 cases in the saline group for statistical analysis. The primary outcome measures were a visual analogue scale (VAS) at postopera-tive 4,12, 24 and 36 h to assess the pain and a verbal rating scale (VRS) to assess the severity and incidence of nausea and vomiting. The secondary indicator were the use of analgesics and antiemetics, blood glucose levels, length of hospital stay, and infection rate at postoperative 30 days. SPSS statistics 22.0 was used for data analysis. Depending on the type of data, analysis of variance, t test, χ2 test, or Fisher′s exact test was used for intergroup comparison. Results Nausea, vomiting, and pain occurred mostly within 24 hours after total knee arthroplasty. The VRS scores, incidence of postoperative nausea and vomiting (PONV) and VAS scores in the dexamethasone group were significantly lower than those in the saline group at postoperative 4,12, 24 h (P<0.05), but the difference was not significant at postoperative 36 hours (P>0.05). The blood glucose in dexamethasone group was significantly higher than that in saline group at postoperative 1 day [(8.5±1.7) vs (5.9±1.4) mmol/L; P<0.05], but the difference at postoperative 3 days was not significant (P>0.05). The mean postoperative hospitalization stay was significantly shorter in the dexamethasone group than in the saline group [(3.0±0.8) d vs (4.8±1.5) d; P<0.05]. There was no significant difference between the two groups in the infection rate at postoperative 30 d (P>0.05). Conclusion Preoperative prophylactic intravenous injection of 10 mg dexamethasone can effectively reduce the severity and incidence of nausea and vomiting in the elderly patients after knee arthroplasty, significantly alleviate postoperative pain, reduce postoperative use of analgesics and antiemetics, and shorten hospital stay.
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