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投稿时间:2018-09-27 网络发布日期:2019-06-21
投稿时间:2018-09-27 网络发布日期:2019-06-21
中文摘要: 目的 探讨地塞米松对髋膝关节置换术患者术后下肢深静脉血栓形成的影响。方法 回顾性分析2015年7月至12月南京鼓楼医院手术治疗髋膝关节置换术224例患者的手术资料,依据术中骨水泥植入前是否使用地塞米松进行分组:地塞米松使用组(A组,n=75)和地塞米松未使用组(B组,n=149)。收集骨水泥植入后10 min内血流动力学数据及血管活性药物使用情况,以及患者出院前双下肢彩超检查下肢深静脉血栓的数据。比较两组患者术中动脉血压降低>20%,血管活性药物使用以及术后下肢深静脉血栓形成的发生率。结果 A组患者中男性比例显著低于B组,差异具有统计学意义(18.7% vs 20.8%,χ2=5.865,P<0.05)。A组患者的出血量高于B组患者,差异具有统计学意义[(284.6±166.2)ml vs (233.5±113.5)ml,t=2.706,P<0.01]。A组患者骨水泥植入后动脉血压降低>20%或需要使用升压药的发生率为29.3%,显著低于B组患者63.1%,差异具有统计学意义(χ2=22.765,P<0.01);A组与B组患者术后下肢深静脉血栓形成的发生率分别为8.0%和6.7%,差异无统计学意义(χ2=0.125,P>0.05)。结论 植入骨水泥前使用地塞米松不能降低术后下肢深静脉血栓形成的发生率,但可以有效预防骨水泥植入后短时间内低血压的发生。
中文关键词: 地塞米松 髋膝关节置换术 下肢深静脉血栓 骨水泥植入 低血压;血流动力学;血管活性药物
Abstract:ObjectiveTo explore the influences of dexamethasone on postoperative lower-limb deep venous thrombosis in patients undergoing hip or knee arthroplasty. Methods A total of 224 patients undergoing hip or knee arthroplasty in Nanjing Drum Tower Hospital from July to December 2015 were included in this study.According to whether dexamethasone was used before intraoperative bone cement implantation or not,the patients were divided into dexamethasone group (group A,n=75) and non-dexamethasone group (group B,n=149).Data of hemodynamic change and use of vasopressors were collected within 10 minutes after bone cement implantation.The deep venous thrombosis in both lower extremities were examined by color Doppler ultrasound before patients discharging.The incidence of arterial blood pressure decreasing above 20%,use of vasopressors and postoperative deep venous thrombosis were compared between two groups. Results The proportion of males in group A was significantly lower than that in group B (18.7% vs 20.8%,χ2=5.865,P<0.05).The blood loss in group A was higher than that in group B[(284.6±166.2)ml vs (233.5±113.5)ml,t=2.706,P<0.01].The incidence of arterial blood pressure decreasing above 20% or the using of vasopressors in group A was statistically lower than that in group B (29.3% vs 63.1%,χ2=22.765,P<0.05).There was no significant difference in the incidence of postoperative lower-limb deep venous thrombosis between group A and group B(8.0% vs 7.0%,χ2=0.125,P>0.05). Conclusion Dexamethasone cannot decrease the incidence of postoperative lower-limb deep venous thrombosis,but it can effectively prevent the occurrence of hypotension after bone cement implantation in hip or knee arthroplasty.
keywords: Dexamethasone Hip or knee arthroplasty Lower-limb deep venous thrombosis Bone cement implantation Hypotension Hemodynamic Vasopressor
文章编号: 中图分类号:R 614 文献标志码:A
基金项目:国家自然科学青年基金(81300951);江苏省医学重点学科(ZDXKA2016018);江苏省青年医学人才(QNRC2016014);江苏省“六大人才高峰”高层次人才选拔培养资助计划(YY-077)
附件
Author Name | Affiliation |
ZHU Xue-wen,ZHANG Wei | Department of Anesthesiology,Drum Tower Hospital Affiliated to Nanjing University Medical School,Nanjing,Jiangsu 210008,China |
引用文本:
朱学文,张伟.地塞米松对髋膝关节置换术患者术后下肢深静脉血栓形成的影响[J].中国临床研究,2019,32(6):763-766.
朱学文,张伟.地塞米松对髋膝关节置换术患者术后下肢深静脉血栓形成的影响[J].中国临床研究,2019,32(6):763-766.