在糖尿病患者的整体部和膝关节关节整形手术期间使用德克萨米他松是否安全?
Kareem J Kebaish1, Jennifer C Wang, Amit S Piple
1From the Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA.
The Journal of the American Academy of Orthopaedic Surgeons
|November 1, 2024
概括
在接受全关节整形手术 (TJA) 的糖尿病患者中,术后使用德克萨米他并没有增加感染性并发症. 这项研究支持TJA期间糖尿病患者使用德克萨米他的安全性,尽管高血糖的风险更高.
科学领域:
- 整形外科手术 整形外科手术
- 内分泌学 在内分泌学.
- 药理学 药理学是指药理学的学科.
背景情况:
- 德克萨米他通常用于全关节整形术 (TJA) 治疗疼痛和恶心.
- 在接受TJA的糖尿病患者中使用德克萨米他的安全性尚未得到充分证实.
研究的目的:
- 评估在接受初级TJA的糖尿病患者中经手术期间使用德克萨米他的安全性和并发症.
- 评估这群人群中德克萨米他使用与术后并发症之间的关联.
主要方法:
- 对Premier医疗保健数据库 (2015-2020年) 进行了回顾性分析.
- 接受初级选择性TJA的糖尿病患者被分为两组:那些接受德甲和那些没有接受德甲的人.
- 多变量逻辑回归被用来分析90天的术后传染性和非传染性并发症.
主要成果:
- 接受德克萨米他的糖尿病患者表现出周围假肢关节感染 (aOR 0.82) 和败血症 (aOR 0.80) 的几率降低.
- 德克萨米他组的住院时间较短.
- 然而,德克萨米他组的术后高血糖症的几率增加了 (aOR 1.14).
结论:
- 经过TJA的糖尿病患者在外科手术期间服用德克萨米他是安全的,因为它与感染性并发症的增加无关.
- 在这种人群中,甲松可能有助于降低感染和败血症风险.
- 在TJA期间接受德克萨米他的糖尿病患者建议密切监测高血糖症.
相关概念视频
Insulin: Dosing Regimen and Adverse Effects
146
Insulin-replacement therapy usually includes both long-acting insulin (basal) and short-acting insulin (to cater to postprandial needs). In a diverse group of type 1 diabetes patients, the average daily insulin dose is typically 0.5-0.7 units/kg body weight. However, obese patients and pubertal adolescents may need more due to insulin resistance.
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
146
Diabetes Mellitus: Type 2 and Gestational
2.2K
Type 2 diabetes, characterized by insulin resistance, arises when the insulin receptors on cells lose responsiveness to insulin, diminishing the cell's capacity to take up glucose, resulting in elevated blood glucose levels. To receive a diagnosis of Type 2 diabetes, a series of blood glucose tests are necessary to assess whether the blood glucose falls within normal parameters. If the result is out of the normal range, a patient may be diagnosed as prediabetic or diabetic, depending on the...
2.2K
Hypoglycemia and Glucagon
152
Without prolonged fasting, healthy individuals maintain blood glucose levels above 3.5 mM due to a well-adapted neuroendocrine counterregulatory system that effectively prevents acute hypoglycemia, a potentially life-threatening condition. The primary clinical scenarios for hypoglycemia encompass diabetes treatment, inappropriate production of endogenous insulin or insulin-like substances by tumors, and the use of glucose-lowering agents in non-diabetic individuals. Notably, hypoglycemia in the...
152
Dipeptidyl Peptidase 4 Inhibitors
172
Dipeptidyl peptidase 4 (DPP-4) is a serine protease widely distributed in the body. It's involved in the inactivation of GLP-1 and GIP hormones, which are crucial for insulin regulation. DPP-4 inhibitors, such as sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin (Tradjenta), alogliptin (Nesina), and vildagliptin (Galvus), help increase the proportion of active GLP-1, enhancing insulin secretion. These inhibitors work by competitively binding to DPP-4. This binding causes a...
172
Oral Hypoglycemic Agents: Biguanides and Glitazones
175
Biguanides, particularly metformin (Glucophage), are insulin sensitizers that enhance glucose uptake, thereby reducing insulin resistance. Unlike sulfonylureas, metformin doesn't prompt insulin secretion, which helps to curb hypoglycemia risk. Metformin is beneficial in treating conditions like polycystic ovary syndrome due to its insulin-resistance reduction capability. The drug's primary action involves curtailing hepatic gluconeogenesis, a significant contributor to high blood...
175
Diabetes: Management and Pharmacotherapy
236
The therapy for diabetes aims to alleviate hyperglycemia-related symptoms, prevent acute metabolic decompensation, and reduce chronic end-organ complications. Glycemic control is evaluated through short-term (self-monitoring, continuous glucose monitoring) and long-term (A1c, fructosamine) metrics, enabling near real-time tracking of blood glucose levels and reflecting glycemic control over specific time frames.
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
236


