【摘要】：目的:通過對患者在全膝關節(jié)置換術中及術后靜脈應用低劑量的甲基潑尼松龍,研究其對全膝關節(jié)置換患者術后惡心嘔吐和術后疼痛的影響及其安全性。方法:遵循嚴格的納入標準和排除標準,選取2015年11月至2016年6月期間因患有膝關節(jié)骨性關節(jié)炎就診于青島大學附屬醫(yī)院關節(jié)外科并擬行單側全膝關節(jié)置換的患者86例。按照隨機數(shù)字表法將所有患者隨機分為甲基潑尼松龍組(43例)和對照組(43例),甲基潑尼松龍組的患者在全膝關節(jié)置換術中選擇應用甲基潑尼松龍40mg靜脈推注作為治療,術后24h內再次予以40mg甲基潑尼松龍靜脈注射治療;對照組患者相同時間段給予等量生理鹽水靜脈注射。觀察記錄兩組患者置換術后0-6 h,6-24 h,24-48 h,48-72 h四個不同時間段的術后惡心嘔吐發(fā)生次數(shù)及置換后0-72 h總發(fā)生次數(shù),記錄置換術后6h,24h,48h,72 h的膝關節(jié)疼痛視覺模擬評分,對置換后第3天患者的膝關節(jié)功能進行評分記錄,分別檢測兩組患者術前、術后的C-反應蛋白值及空腹血糖值。觀察兩組患者術后的飲食、睡眠質量及精神狀態(tài)等。術后隨訪6個月,復查并記錄兩組患者有無術后感染、切口愈合不良等并發(fā)癥的發(fā)生。結果:兩組患者共86例全部納入結果分析,無失訪病例。兩組患者的性別、年齡、體質量指數(shù)、手術時間等一般資料比較,差異無統(tǒng)計學意義(P0.05);在術后惡心嘔吐發(fā)生方面,甲基潑尼松龍組患者在置換術后0-72h惡心嘔吐總發(fā)生率(25.6%)要低于對照組(55.8%),且甲基潑尼松龍組置換術后0-6h、6-24h兩個時間段內的惡心嘔吐發(fā)生率(16.3%,18.6%)均低于對照組(41.9%,32.6%),差異均有統(tǒng)計學意義(P0.05),兩組患者術后24-48h及48-72h時間段內的惡心嘔吐發(fā)生率比較均無統(tǒng)計學意義(P0.05);在置換術后24h和術后48h的疼痛視覺模擬評分上,甲基潑尼松龍組患者的評分均低于對照組,差異有統(tǒng)計學意義(P0.05),而術后6h和72h的疼痛視覺模擬評分比較,兩組之間無統(tǒng)計學意義(P0.05);另外,全膝關節(jié)置換術后第3天甲基潑尼松龍組患者的膝關節(jié)功能評分(KSS)要高于對照組(P0.05);兩組患者置換前后測定的C-反應蛋白值、空腹血糖值差異無統(tǒng)計學意義(P0.05)。全膝關節(jié)置換術后隨訪6個月,復查發(fā)現(xiàn)兩組患者的手術切口均達到一期愈合,均未發(fā)生術后感染、切口愈合不良等并發(fā)癥。結論:通過在人工全膝關節(jié)置換術中和術后24h內予以靜脈應用甲基潑尼松龍治療,發(fā)現(xiàn)甲基潑尼松龍可以顯著減少全膝關節(jié)置換患者術后惡心嘔吐的發(fā)生次數(shù)和減輕術后疼痛,且隨訪發(fā)現(xiàn)膝關節(jié)置換術后感染等并發(fā)癥的發(fā)生率并未有所增加,安全性良好。甲基潑尼松龍的應用有助于患者行全膝關節(jié)置換術后進行早期關節(jié)功能康復鍛煉,另外為行全膝關節(jié)置換手術的患者術后得以快速康復提供了新的臨床思路。
[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.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R687.4

【參考文獻】

相關期刊論文 前10條

1 陳志;李金龍;于浩達;周宗科;沈彬;楊靜;康鵬德;裴福興;;快速康復理念運用于初次全髖關節(jié)置換術的有效性評價[J];實用骨科雜志;2016年07期

2 何勇;劉欣偉;張敬東;孫保飛;韓文鋒;劉松波;劉海立;;快速康復外科理念在初次行人工全膝關節(jié)置換術圍術期臨床應用[J];創(chuàng)傷與急危重病醫(yī)學;2016年04期

3 薛慶云;王坤正;裴福興;朱漢民;金大地;陶天遵;李恩;李寧華;張耀南;王曉濱;紀泉;;中國40歲以上人群原發(fā)性骨關節(jié)炎患病狀況調查[J];中華骨科雜志;2015年12期

4 俞磊;張成歡;包倪榮;趙建寧;;靜脈應用糖皮質激素改善膝關節(jié)置換術后PONV和疼痛的meta分析[J];臨床與病理雜志;2015年11期

5 高業(yè)剛;何永鳳;郭錫恩;;單次不同劑量地塞米松對股骨頸骨折空心釘內固定術后鎮(zhèn)痛的影響[J];臨床麻醉學雜志;2015年07期

6 郇松瑋;姚平;劉寧;李R既，

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