临床骨科杂志
臨床骨科雜誌
림상골과잡지
JOURNAL OF CLINICAL ORTHOPAEDICS
2015年
3期
318-321
,共4页
地塞米松%雷莫司琼%关节成形术,置换,膝%呕吐%疼痛
地塞米鬆%雷莫司瓊%關節成形術,置換,膝%嘔吐%疼痛
지새미송%뢰막사경%관절성형술,치환,슬%구토%동통
dexamethasone%ramosetron%arthroplasty,replacement,knee%emesis%pain
目的：探讨术前静脉用小剂量地塞米松对减少单侧全膝关节置换（TKA）术后恶心呕吐及术后早期疼痛的有效性及安全性。方法将90例拟行 TKA 患者随机分为 A 组（45例）与 B 组（45例）。A 组患者于术前1 h 静推地塞米松10 mg，手术完成后立即静推0．3 mg 雷莫司琼；B 组患者仅术后静推同等剂量的雷莫司琼。观察记录：患者术后6、24、48、72 h 的恶心呕吐发生率、严重程度、是否完全缓解，患者术后6、24、48、72h VAS 评分及术后3、6、12个月 KSS 评分，术后手术切口情况及1年内假体感染等并发症。结果A 组患者术后3 d 总的恶心呕吐发生率及0～6 h 恶心呕吐发生率低于 B 组，差异有统计学意义（P ＜0．05），其余时间段恶心呕吐发生率两组差异均无统计学意义（P ＞0．05）。A 组术后24、48 h VAS 评分低于 B 组，差异有统计学意义（P ＜0．05）。术后 KSS 评分两组比较差异无统计学意义（P ＞0．05）。两组患者术后血糖值均在正常范围之内，术后手术切口均一期愈合。术后随访1年均未发生关节感染等并发症。结论单侧 TKA 患者术前预防性静推小剂量地塞米松及术后联合雷莫司琼可以减少术后恶心呕吐及早期疼痛，并不增加手术后相关并发症。
目的：探討術前靜脈用小劑量地塞米鬆對減少單側全膝關節置換（TKA）術後噁心嘔吐及術後早期疼痛的有效性及安全性。方法將90例擬行 TKA 患者隨機分為 A 組（45例）與 B 組（45例）。A 組患者于術前1 h 靜推地塞米鬆10 mg，手術完成後立即靜推0．3 mg 雷莫司瓊；B 組患者僅術後靜推同等劑量的雷莫司瓊。觀察記錄：患者術後6、24、48、72 h 的噁心嘔吐髮生率、嚴重程度、是否完全緩解，患者術後6、24、48、72h VAS 評分及術後3、6、12箇月 KSS 評分，術後手術切口情況及1年內假體感染等併髮癥。結果A 組患者術後3 d 總的噁心嘔吐髮生率及0～6 h 噁心嘔吐髮生率低于 B 組，差異有統計學意義（P ＜0．05），其餘時間段噁心嘔吐髮生率兩組差異均無統計學意義（P ＞0．05）。A 組術後24、48 h VAS 評分低于 B 組，差異有統計學意義（P ＜0．05）。術後 KSS 評分兩組比較差異無統計學意義（P ＞0．05）。兩組患者術後血糖值均在正常範圍之內，術後手術切口均一期愈閤。術後隨訪1年均未髮生關節感染等併髮癥。結論單側 TKA 患者術前預防性靜推小劑量地塞米鬆及術後聯閤雷莫司瓊可以減少術後噁心嘔吐及早期疼痛，併不增加手術後相關併髮癥。
목적：탐토술전정맥용소제량지새미송대감소단측전슬관절치환（TKA）술후악심구토급술후조기동통적유효성급안전성。방법장90례의행 TKA 환자수궤분위 A 조（45례）여 B 조（45례）。A 조환자우술전1 h 정추지새미송10 mg，수술완성후립즉정추0．3 mg 뢰막사경；B 조환자부술후정추동등제량적뢰막사경。관찰기록：환자술후6、24、48、72 h 적악심구토발생솔、엄중정도、시부완전완해，환자술후6、24、48、72h VAS 평분급술후3、6、12개월 KSS 평분，술후수술절구정황급1년내가체감염등병발증。결과A 조환자술후3 d 총적악심구토발생솔급0～6 h 악심구토발생솔저우 B 조，차이유통계학의의（P ＜0．05），기여시간단악심구토발생솔량조차이균무통계학의의（P ＞0．05）。A 조술후24、48 h VAS 평분저우 B 조，차이유통계학의의（P ＜0．05）。술후 KSS 평분량조비교차이무통계학의의（P ＞0．05）。량조환자술후혈당치균재정상범위지내，술후수술절구균일기유합。술후수방1년균미발생관절감염등병발증。결론단측 TKA 환자술전예방성정추소제량지새미송급술후연합뢰막사경가이감소술후악심구토급조기동통，병불증가수술후상관병발증。
Objective To explore the safety,efficacy and whether the addition of dexamethasone to a protocol inclu-ding ramosetron further reduces postoperative emesis and whether it reduces postoperative pain after total knee arthro-plasty (TKA).Methods 90 of unilateral TKA were randomly divided into two groups:the Group A(n =45)for all patients undergoing TKA were administrated dexamethasone(10mg)1 h before surgery and ramosetron(0.3mg)im-mediately after surgery;Group B(n =45)were administrated immediately 0.3mg ramosetron through intravenous a-lone postoperatively.It was recorded for the incidence of postoperative nausea and vomiting (PONV),severity of nau-sea and complete response if or not.Patients were assessed 0 to 6,6 to 24,24 to 48,and 48 to 72 h postoperatively. At the same time the VAS scores at the 6,24,48,72 h and KSS scores in the 3,6,12 months postoperation were recor-ded.In addition,patients were evaluated for wound complications and periprosthetic joint infections at a minimum of 1 year after surgery.Results The group A had a lower incidence of PONV during the entire 72h evaluation period and experienced less severe nausea for the first 6 h compared with group B after TKA(P <0.05),although not between 6 to 72 h and there was not difference in other time between the two groups(P >0.05).Patients in the group A experi-enced lower VAS scores at the 24,48h and during the overall study period(P <0.05).No differences were found in wound complications and KSS scores between the groups(P >0.05).Postoperative blood glucose levels were in the normal range between the two groups,incision of all patients healed and each group had no case of periprosthetic joint infection and the other complications in one year postoperation.Conclusions Patients who received prophylactic dexamethasone in addition to ramosetron have reduced postoperative emesis and pain without increasing risks for wound complications,compared with patients who received ramosetron alone in patients after TKA.
