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在现代整体关节和膝关节关节整形手术中的外科手术系统性皮质类固醇:临床实践的入门书
Ryan C Palmer1, Ian A Jones2, Peter K Sculco3
1Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California.
建议使用外科皮质类固醇,以减少部或膝关节置换手术后的恶心和吐. 它们还可以减少疼痛和住院,而8-16毫克德克萨米他的剂量似乎是安全的.
科学领域:
- 麻醉学 麻醉学
- 整形外科手术 整形外科手术
- 药理学 药理学是指药理学的学科.
背景情况:
- 手术后恶心和吐 (PONV) 是主要的骨科手术后的常见并发症.
- 皮质类固醇因其抗和抗炎性质而越来越多地被考虑用于外科手术期间的管理.
研究的目的:
- 评估在接受选择性全关节或全膝关节关节整形手术的患者中术后皮质类固醇的疗效和安全性.
- 评估皮质类固醇对术后疼痛的影响,阿片类药物需求和其他临床结果.
主要方法:
- 随机对照试验和观察性研究的系统审查和元分析.
- 结果分析包括PONV发病率和严重程度,疼痛评分,阿片类药物消费,停留时间和并发症.
主要成果:
- 术后使用的皮质类固醇可显著降低PONV的发病率和严重程度.
- 皮质类固醇可以降低术后疼痛和阿片类药物需求.
- 有证据表明,它对停留时间,静脉血栓栓塞,运动能力,妄想,急性损伤和骨植入综合征具有中性到积极的影响.
- 过渡性高血糖可能发生,但缺乏强有力的证据将其与增加的传染性并发症联系起来.
结论:
- 强烈建议在PONV预防和治疗中使用外科皮质类固醇,用于全关节和膝关节整形术.
- 剂量是关键的;8-16毫克德甲或同等剂量似乎是合理的和安全的.
- 需要进一步的研究来澄清最佳的剂量策略和长期影响.
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