| 王同园,张明勇,张重阳.静脉注射糖皮质激素在膝关节置换术围术期应用的系统综述.骨科,2025,16(3): 213-218. |
| 静脉注射糖皮质激素在膝关节置换术围术期应用的系统综述 |
| Intravenous glucocorticoids in the perioperative period of knee joint replacement surgery: a systematic review |
| 投稿时间：2024-11-02 |
| DOI：10.3969/j.issn.1674-8573.2025.03.004 |
| 中文关键词: 糖皮质激素 膝关节置换 地塞米松 围术期 |
| 英文关键词: Glucocorticoids Total knee arthroplasty Dexamethasone Perioperative period |
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| 中文摘要: |
| 目的 对全膝关节置换术（TKA）围手术期静脉应用糖皮质激素的最新进展及其可能对预后产生的影响进行综述。方法 通过数据库检索并阅读相关文献，对最新发表的相关高质量随机对照试验进行归纳总结，以确定围手术期静脉应用糖皮质激素对TKA术后预后的影响。结果 本文最终纳入11项研究，包含1 580例。在11项研究中有10项报告静脉注射糖皮质激素改善了疼痛评分。大多数研究发现糖皮质激素静脉给药与恶心呕吐发生率降低显著相关，一部分研究报告了术后恶心评分的显著改善。大多数研究发现术后C反应蛋白水平显著降低。在所有纳入的11项研究中，无论评估的并发症结局如何，静脉注射糖皮质激素组与对照组术后并发症发生率差异无统计学意义（P＞0.05）。结论 本综述支持围手术期静脉使用糖皮质激素缓解术后疼痛、恶心和降低炎症标志物水平。需要更多的高质量随机对照试验来分析TKA围手术期糖皮质激素应用的最佳剂量、给药方法和给药时间。 |
| 英文摘要: |
| Objective To review the latest developments and potential prognostic effects of perioperative intravenous glucocorticoid administration in total knee arthroplasty (TKA). Methods Through database searches and review of relevant literature, the latest published high-quality randomized controlled trials were summarized to determine the effects of perioperative intravenous glucocorticoid administration on postoperative outcomes in TKA. Results This review ultimately included 11 studies, encompassing 1 580 patients. Among the 11 studies, 10 reported that intravenous glucocorticoids improved pain scores. Regarding postoperative nausea and vomiting (PONV), most studies found a significant correlation between intravenous glucocorticoids and a reduced incidence of PONV, with some studies reporting significant improvements in postoperative nausea scores. Concerning inflammatory markers, most studies found a significant decrease in postoperative C-reactive protein levels. In all 11 studies included, regardless of the assessed complication outcomes, there was no significant difference in the incidence of postoperative complications between the glucocorticoid group and the control group. Conclusion This review supports the use of perioperative intravenous glucocorticoids for alleviating postoperative pain, nausea, and reducing inflammatory marker levels. More high-quality randomized controlled trials are needed to analyze the optimal dose, administration method, and timing of glucocorticoid application in the perioperative period of TKA. |
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