| 围手术期地塞米松对全膝关节置换术后恶心呕吐和疼痛的影响 |
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投稿时间：2019-10-20
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| 作者 | Author | 单位 | Address | E-Mail |
| 刘敏 |
LIU Min |
温州医科大学附属第三医院骨科, 浙江 温州 325204 |
Department of Orthopaedics, the Third Affiliated Hospital of Wenzhou Medical University, Wenzhou 325200, Zhejiang, China |
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| 周如聪 |
ZHOU Ru-cong |
温州医科大学附属第三医院骨科, 浙江 温州 325204 |
Department of Orthopaedics, the Third Affiliated Hospital of Wenzhou Medical University, Wenzhou 325200, Zhejiang, China |
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| 周晓赛 |
ZHOU Xiao-sai |
瑞安市中医院放射科, 浙江 温州 325204 |
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| 刘良乐 |
LIU Liang-le |
温州医科大学附属第三医院骨科, 浙江 温州 325204 |
Department of Orthopaedics, the Third Affiliated Hospital of Wenzhou Medical University, Wenzhou 325200, Zhejiang, China |
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| 王伟良 |
WANG Wei-liang |
温州医科大学附属第三医院骨科, 浙江 温州 325204 |
Department of Orthopaedics, the Third Affiliated Hospital of Wenzhou Medical University, Wenzhou 325200, Zhejiang, China |
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| 蔡春元 |
CAI Chun-yuan |
温州医科大学附属第三医院骨科, 浙江 温州 325204 |
Department of Orthopaedics, the Third Affiliated Hospital of Wenzhou Medical University, Wenzhou 325200, Zhejiang, China |
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| 吴丽芬 |
WU Li-fen |
温州医科大学附属第三医院骨科, 浙江 温州 325204 |
Department of Orthopaedics, the Third Affiliated Hospital of Wenzhou Medical University, Wenzhou 325200, Zhejiang, China |
rahosjoint@163.com |
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| 期刊信息：《中国骨伤》2019年，第32卷，第5期，第423-427页 |
| DOI：10.3969/j.issn.1003-0034.2019.05.007 |
| 基金项目: |
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中文摘要:
目的：探讨围手术期应用地塞米松对于单侧全膝关节置换术后恶心呕吐和疼痛的影响及安全性评估。
方法：2014年2月至2016年6月采用全膝关节置换治疗的单侧晚期骨性关节炎患者100例，分为2组，每组50例：其中地塞米松组，男27例，女23例，年龄（72.30±7.02）岁，术前给予地塞米松10 mg静脉滴注；生理盐水组，男26例，女24例，年龄（71.30±6.08）岁，相应时间给予等量生理盐水静滴。观察记录术后2、4、6、8、12、24、36、48 h时休息时和屈膝45°时疼痛VAS评分，记录术后0~24 h和24~48 h发生呕吐情况、使用止吐药及阿片类药情况。并记录术后患者药物副作用及并发症。
结果：100例患者均获得随访，平均随访时间14.5个月。休息时疼痛VAS评分地塞米松组术后8、24、48 h时低于生理盐水组（P<0.05）；屈膝45°时VAS评分地塞米松组术后8、48 h时低于生理盐水组（P<0.05）；地塞米松组休息时和屈膝45°时VAS评分总体低于生理盐水组（P<0.05）。术后0~24 h、24~48 h阿片类药用量及总阿片类药用量地塞米松组均低于生理盐水组（P<0.05）。两组患者术后0~24 h和24~48 h发生恶心呕吐比例，术后0~24 h要求使用止吐药比例差异均有统计学意义（P<0.05）。总止吐药用量地塞米松组少于生理盐水组（P<0.05）。截止末次随访，两组患者未出现术后感染、消化道溃疡、出血等并发症。
结论：术前全身应用地塞米松可有效减少TKA术后疼痛和恶心呕吐，且并不增加术后并发症。 |
| 【关键词】骨关节炎,膝 关节成形术,置换,膝 地塞米松 疼痛 恶心 呕吐 |
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| Effect of perioperative dexamethasone on nausea,vomiting and pain after total knee arthroplasty |
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ABSTRACT
Objective:To investigate the effect of perioperative dexamethasone on nausea,vomiting and pain after unilateral total knee arthroplasty and to evaluate its safety.
Methods:From February 2014 to June 2016,100 patients with unilateral advanced osteoarthritis treated by total knee arthroplasty were divided into two groups:50 patients in dexamethasone group including 27 males and 23 females,aged (72.30±7.02) years,were given intravenous drip of dexamethasone 10 mg before operation;50 patients in saline group,including 26 males and 24 females,aged (71.30±6.08) years,were given the same amount of saline at the corresponding time. The VAS scores of pain at rest and at 45 degrees of knee flexion were recorded at 2,4,6,8,12,24,36 and 48 h after operation. Vomiting,antiemetic drugs and opioids were recorded at 0 to 24 h and 24 to 48 h after operation. The side effects and complications were recorded.
Results:All the 100 patients were followed up for an average of 14.5 months. VAS score of pain at rest in dexamethasone group was lower than that in saline group at 8,24 and 48 h after operation (P<0.05);VAS score of dexamethasone group at 45 degrees after knee flexion was lower than that of saline group at 8 and 48 h after operation(P<0.05);VAS score of dexamethasone group at rest and 45 degrees after knee flexion was lower than that of saline group(P<0.05). The dosage of opioids and total opioids in dexamethasone group was lower than that in saline group at 0 to 24 h,24 to 48 h after operation (P<0.05). The proportion of nausea and vomiting occurred at 0 to 24 h and 24 to 48 h after operation,and the proportion of antiemetic required at 0 to 24 h after operation had statistical significance between two groups(P<0.05). The total antiemetic dosage of dexamethasone group was less than that of saline group(P<0.05). As of the last follow-up,no complications such as infection,gastrointestinal ulcer and bleeding occurred in the two groups.
Conclusion:Preoperative systemic application of dexamethasone can effectively reduce pain and nausea and vomiting after TKA without increasing postoperative complications. |
| KEY WORDS Osteoarthritis,knee Arthroplasty,Replacement,Knee Dexamethasone Pain Nausea Vomiting |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 刘敏,周如聪,周晓赛,刘良乐,王伟良,蔡春元,吴丽芬.围手术期地塞米松对全膝关节置换术后恶心呕吐和疼痛的影响[J].中国骨伤,2019,32(5):423~427 |
| 英文格式: | LIU Min,ZHOU Ru-cong,ZHOU Xiao-sai,LIU Liang-le,WANG Wei-liang,CAI Chun-yuan,WU Li-fen.Effect of perioperative dexamethasone on nausea,vomiting and pain after total knee arthroplasty[J].zhongguo gu shang / China J Orthop Trauma ,2019,32(5):423~427 |
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