甲基潑尼松龍對(duì)全膝關(guān)節(jié)置換術(shù)后惡心嘔吐和疼痛的影響及安全性研究
發(fā)布時(shí)間：2018-11-10 18:49
【摘要】：目的:通過對(duì)患者在全膝關(guān)節(jié)置換術(shù)中及術(shù)后靜脈應(yīng)用低劑量的甲基潑尼松龍,研究其對(duì)全膝關(guān)節(jié)置換患者術(shù)后惡心嘔吐和術(shù)后疼痛的影響及其安全性。方法:遵循嚴(yán)格的納入標(biāo)準(zhǔn)和排除標(biāo)準(zhǔn),選取2015年11月至2016年6月期間因患有膝關(guān)節(jié)骨性關(guān)節(jié)炎就診于青島大學(xué)附屬醫(yī)院關(guān)節(jié)外科并擬行單側(cè)全膝關(guān)節(jié)置換的患者86例。按照隨機(jī)數(shù)字表法將所有患者隨機(jī)分為甲基潑尼松龍組(43例)和對(duì)照組(43例),甲基潑尼松龍組的患者在全膝關(guān)節(jié)置換術(shù)中選擇應(yīng)用甲基潑尼松龍40mg靜脈推注作為治療,術(shù)后24h內(nèi)再次予以40mg甲基潑尼松龍靜脈注射治療;對(duì)照組患者相同時(shí)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(shù)后0-6 h,6-24 h,24-48 h,48-72 h四個(gè)不同時(shí)間段的術(shù)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(shù)后6h,24h,48h,72 h的膝關(guān)節(jié)疼痛視覺模擬評(píng)分,對(duì)置換后第3天患者的膝關(guān)節(jié)功能進(jìn)行評(píng)分記錄,分別檢測(cè)兩組患者術(shù)前、術(shù)后的C-反應(yīng)蛋白值及空腹血糖值。觀察兩組患者術(shù)后的飲食、睡眠質(zhì)量及精神狀態(tài)等。術(shù)后隨訪6個(gè)月,復(fù)查并記錄兩組患者有無術(shù)后感染、切口愈合不良等并發(fā)癥的發(fā)生。結(jié)果:兩組患者共86例全部納入結(jié)果分析,無失訪病例。兩組患者的性別、年齡、體質(zhì)量指數(shù)、手術(shù)時(shí)間等一般資料比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05);在術(shù)后惡心嘔吐發(fā)生方面,甲基潑尼松龍組患者在置換術(shù)后0-72h惡心嘔吐總發(fā)生率(25.6%)要低于對(duì)照組(55.8%),且甲基潑尼松龍組置換術(shù)后0-6h、6-24h兩個(gè)時(shí)間段內(nèi)的惡心嘔吐發(fā)生率(16.3%,18.6%)均低于對(duì)照組(41.9%,32.6%),差異均有統(tǒng)計(jì)學(xué)意義(P0.05),兩組患者術(shù)后24-48h及48-72h時(shí)間段內(nèi)的惡心嘔吐發(fā)生率比較均無統(tǒng)計(jì)學(xué)意義(P0.05);在置換術(shù)后24h和術(shù)后48h的疼痛視覺模擬評(píng)分上,甲基潑尼松龍組患者的評(píng)分均低于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05),而術(shù)后6h和72h的疼痛視覺模擬評(píng)分比較,兩組之間無統(tǒng)計(jì)學(xué)意義(P0.05);另外,全膝關(guān)節(jié)置換術(shù)后第3天甲基潑尼松龍組患者的膝關(guān)節(jié)功能評(píng)分(KSS)要高于對(duì)照組(P0.05);兩組患者置換前后測(cè)定的C-反應(yīng)蛋白值、空腹血糖值差異無統(tǒng)計(jì)學(xué)意義(P0.05)。全膝關(guān)節(jié)置換術(shù)后隨訪6個(gè)月,復(fù)查發(fā)現(xiàn)兩組患者的手術(shù)切口均達(dá)到一期愈合,均未發(fā)生術(shù)后感染、切口愈合不良等并發(fā)癥。結(jié)論:通過在人工全膝關(guān)節(jié)置換術(shù)中和術(shù)后24h內(nèi)予以靜脈應(yīng)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(guān)節(jié)置換患者術(shù)后惡心嘔吐的發(fā)生次數(shù)和減輕術(shù)后疼痛,且隨訪發(fā)現(xiàn)膝關(guān)節(jié)置換術(shù)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(yīng)用有助于患者行全膝關(guān)節(jié)置換術(shù)后進(jìn)行早期關(guān)節(jié)功能康復(fù)鍛煉,另外為行全膝關(guān)節(jié)置換手術(shù)的患者術(shù)后得以快速康復(fù)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(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.4
[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(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.4
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