甲基泼尼松龙对全膝关节置换术后恶心呕吐和疼痛的影响及安全性研究

发布时间：2018-11-10 18:49

【摘要】：目的:通过对患者在全膝关节置换术中及术后静脉应用低剂量的甲基泼尼松龙,研究其对全膝关节置换患者术后恶心呕吐和术后疼痛的影响及其安全性。方法:遵循严格的纳入标准和排除标准,选取2015年11月至2016年6月期间因患有膝关节骨性关节炎就诊于青岛大学附属医院关节外科并拟行单侧全膝关节置换的患者86例。按照随机数字表法将所有患者随机分为甲基泼尼松龙组(43例)和对照组(43例),甲基泼尼松龙组的患者在全膝关节置换术中选择应用甲基泼尼松龙40mg静脉推注作为治疗,术后24h内再次予以40mg甲基泼尼松龙静脉注射治疗;对照组患者相同时间段给予等量生理盐水静脉注射。观察记录两组患者置换术后0-6 h,6-24 h,24-48 h,48-72 h四个不同时间段的术后恶心呕吐发生次数及置换后0-72 h总发生次数,记录置换术后6h,24h,48h,72 h的膝关节疼痛视觉模拟评分,对置换后第3天患者的膝关节功能进行评分记录,分别检测两组患者术前、术后的C-反应蛋白值及空腹血糖值。观察两组患者术后的饮食、睡眠质量及精神状态等。术后随访6个月,复查并记录两组患者有无术后感染、切口愈合不良等并发症的发生。结果:两组患者共86例全部纳入结果分析,无失访病例。两组患者的性别、年龄、体质量指数、手术时间等一般资料比较,差异无统计学意义(P0.05);在术后恶心呕吐发生方面,甲基泼尼松龙组患者在置换术后0-72h恶心呕吐总发生率(25.6%)要低于对照组(55.8%),且甲基泼尼松龙组置换术后0-6h、6-24h两个时间段内的恶心呕吐发生率(16.3%,18.6%)均低于对照组(41.9%,32.6%),差异均有统计学意义(P0.05),两组患者术后24-48h及48-72h时间段内的恶心呕吐发生率比较均无统计学意义(P0.05);在置换术后24h和术后48h的疼痛视觉模拟评分上,甲基泼尼松龙组患者的评分均低于对照组,差异有统计学意义(P0.05),而术后6h和72h的疼痛视觉模拟评分比较,两组之间无统计学意义(P0.05);另外,全膝关节置换术后第3天甲基泼尼松龙组患者的膝关节功能评分(KSS)要高于对照组(P0.05);两组患者置换前后测定的C-反应蛋白值、空腹血糖值差异无统计学意义(P0.05)。全膝关节置换术后随访6个月,复查发现两组患者的手术切口均达到一期愈合,均未发生术后感染、切口愈合不良等并发症。结论:通过在人工全膝关节置换术中和术后24h内予以静脉应用甲基泼尼松龙治疗,发现甲基泼尼松龙可以显著减少全膝关节置换患者术后恶心呕吐的发生次数和减轻术后疼痛,且随访发现膝关节置换术后感染等并发症的发生率并未有所增加,安全性良好。甲基泼尼松龙的应用有助于患者行全膝关节置换术后进行早期关节功能康复锻炼,另外为行全膝关节置换手术的患者术后得以快速康复提供了新的临床思路。
[Abstract]:Objective: to study the effect and safety of low dose methylprednisolone on nausea and vomiting and postoperative pain after total knee arthroplasty. Methods: according to the strict inclusion criteria and exclusion criteria, 86 patients with osteoarthritis of knee were selected from November 2015 to June 2016 in the Department of Arthroplasty of knee Joint of Qingdao University affiliated Hospital and planned to perform unilateral total knee arthroplasty. All the patients were randomly divided into methylprednisolone group (43 cases) and control group (43 cases) according to the random number table method. The patients in methylprednisolone group were treated by intravenous injection of methylprednisolone 40mg during total knee arthroplasty. 40mg methylprednisolone was injected intravenously within 24 hours after operation. Patients in the control group were given the same amount of saline intravenously at the same time. The frequency of postoperative nausea and vomiting and the total frequency of postoperative nausea and vomiting were recorded at 0-6 h, 6-24 h, 24-48 h, 48-72 h after replacement and from 0 h to 72 h after replacement, and 24 h and 48 h after replacement, respectively. The visual analogue score of knee joint pain at 72 hours was used to record the knee joint function of the patients on the 3rd day after replacement. The C-reactive protein and fasting blood glucose were measured before and after operation in both groups. The diet, sleep quality and mental state of the two groups were observed. Follow up for 6 months, recheck and record the two groups of patients with postoperative infection, wound healing and other complications. Results: 86 patients in both groups were included in the result analysis. There was no significant difference in sex, age, body mass index and operation time between the two groups (P0.05). The incidence of nausea and vomiting in methylprednisolone group was significantly lower than that in control group (25.6%) 0-72 hours after replacement (55.8%), and the incidence of nausea and vomiting in methylprednisolone group was 0-6 hours after replacement. The incidence of nausea and vomiting (16.3%) was significantly lower than that in the control group (41.9%) (P0.05). There was no significant difference in the incidence of nausea and vomiting between the two groups in 24-48 hours and 48-72 hours postoperatively (P0.05). The scores of visual analogue of pain in methylprednisolone group were significantly lower than those in control group at 24 hours after replacement and 48 hours after operation (P0.05), while the visual analogue scores of pain at 6 hours and 72 hours after operation were compared. There was no statistical significance between the two groups (P0.05); In addition, the (KSS) of the patients in the methylprednisolone group was higher than that in the control group on the 3rd day after total knee arthroplasty (P0.05). There was no significant difference in C-reactive protein and fasting blood glucose between the two groups before and after replacement (P0.05). The patients were followed up for 6 months after total knee arthroplasty. It was found that the surgical incisions of the two groups reached primary healing without postoperative infection, poor wound healing and other complications. Conclusion: methylprednisolone was administered intravenously in total knee arthroplasty and 24 hours after operation. It was found that methylprednisolone could significantly reduce the incidence of nausea and vomiting and relieve postoperative pain in patients with total knee arthroplasty. The incidence of complications such as infection after knee arthroplasty was not increased and the safety was good. The application of methylprednisolone is helpful to the rehabilitation of early joint function after total knee arthroplasty and provides a new clinical idea for the rapid recovery of patients undergoing total knee arthroplasty.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

【参考文献】