CAJ | 학술논문

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10 mg,术后第1、2、3天每天给予5 mg静脉推注,给予S组术中生理盐水10 mg,术后第1、2、3天分别给予5 mg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14 d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.
목적 탐토소제량당피질격소재고령관절치환환자위수술기응용적안전성화유효성.방법 선택아과75세이상택기관절치환수술환자78례,수궤분위지새미송조(A조)화대조조(S조)각39례.술중급여A조지새미송10 mg,술후제1、2、3천매천급여5 mg정맥추주,급여S조술중생리염수10 mg,술후제1、2、3천분별급여5 mg정맥추주.관찰환자술후체온、동통평분등지표병진행통계학분석.결과 량조공78례환자무일례출현감염,균재술후14 d탁선후순리출원,기중지새미송조술후제1、3천동통평분(균치위2.744、1.769)명현소우대조조(균치위3.385、2.308,P＜0.01),술후제3천여술전1d체온파동치소우대조조(P＜0.01).지새미송조여대조조술후제3천여술전제1천혈청백단백(P＞0.05)、공복혈당파동치차이무통계학의의(P＞0.05).지새미송조술후제3천(슬)관절활동도슬관절평분계통(HSS)평분(P＜0.01)급관관절Harris평분(P＜0.05)명현고우대조조.실험조술후적식욕급정신상태명현호우대조조.결론 고령관절치환환자위수술기응용소제량당피질격소,가현저강저불량사건발생솔,제고위수술기안전성,병미증가응용당피질격소병발증.
Objective To evaluate the efficacy and safety of low dose glucocorticoid during surgery of joinreplacemenin old patients.Method78 casepatientaged ovethan 78 yearold were randomly divided into the dexamethasone group (group A, n =39) and control group (group S, n =39).All casewere accepted operation of joinreplacement.Group were given dexamethasone 10 mg in intraoperative, extr5 mg peday wagiven on 1,2, 3 day afteoperation.Group were give 10 ml saline in intraoperative, 5 ml peday were given on 1, 2, 3 day postoperatively.Temperature, pain score, knee joinscoring system (HSS) score, Harriscore and the change of serum albumin were evaluated.ResultAll 78 patientwere discharged on 14 dayaftesurgery withouany infection cases.Pain score in group wa2.7 on the firsday and 1.8 on the third day, which wasignificanlowethan group eitheon the firsday (3.385) othe third day (2.308,P ＜0.01).The temperature in group wastable compared with group on the firsday othe third day (P ＜ 0.01).There wano difference between two groupon the third day afteoperation in serum albumin (P ＞ 0.05) and levelof fasting blood glucose (P ＞ 0.05).HSscore (P ＜ 0.05) and Harrihip score (P ＜ 0.05) were much bettein group than in group on the third day postoperatively.Conclusion Application of low-dose glucocorticoidisafe in joinreplacemenpatientpreoperatively.Ican significantly reduce pain and improve activity withouany more complicationlike infection.