地塞米松对老年股骨粗隆间骨折围手术期的影响△

Effect of dexamethasone on perioperative reactions of femoral intertrochanteric fractures in elderly

摘要:

[目的] 探讨地塞米松在老年股骨粗隆间骨折围术期应用的疗效及安全性。[方法] 2021 年7 月—2023 年7 月行手术治疗的粗隆间骨折患者共105 例，采用随机数字表法分成空白组、单次组及多次组，每组35 例。分别给予相应的地塞米松次数，比较三组临床及检验结果。[结果] 三组患者均顺利完成手术，多次组术后曲马多用量[(60.4±13.2) mg vs (90.3±20.3) mgvs (75.4±17.6) mg, P＜0.001] 及甲氧氯普氨用量[(7.7±3.8) mg vs (13.1±5.1) mg vs (10.5±3.1) mg, P＜0.001] 显著少于空白组和单次组。围术期恶心、呕吐发生率，多次组＜单次组＜空白组[例(%), 3 (8.6) vs 7 (20.0) vs 10 (28.6), P＜0.001]。与术前相比，三组患者术后第1、3 d，ICFS、PSQI、VAS 评分均显著减少（P＜0.05）。术后第3 d，多次组、PSQI 评分、VAS 评分显著优于空白组和单次组（P＜0.05）。检验方面，术前三组间WBC、CRP、IL-6 的差异均无统计学意义（P＞0.05），术后第3 d，多次组、单次组的WBC [(9.7±2.6)×10⁹/L vs (10.5±2.4)×10⁹/L vs (12.8±3.2)×10⁹/L, P＜0.001]、CRP [(19.2±6.9) mg/L vs (27.6±8.7) mg/L vs (39.4±10.2) mg/L,P＜0.001]、IL-6 [(32.6±9.6) pg/ml vs (42.8±9.7) pg/ml vs (64.7±11.4) pg/ml, P＜0.001] 均显著低于空白组。[结论] 股骨粗隆间骨折围术期多次应用小剂量地塞米松不仅能减轻疼痛，改善睡眠，缓解围术期疲乏，且不增加激素相关并发症发生风险。

Abstract:

[Objective] To investigate the efficacy and safety of dexamethasone used in perioperative period of femoral intertrochanter-ic fractures in elderly. [Methods] A total of 105 patients who underwent surgical treatments for femoral intertrochanteric fracture in our hos-pital from July 2021 to July 2023 were included and randomly divided into blank group, single-dose group and multiple-dose group by ran-dom number table method, with 35 cases in each group. The patients were given corresponding dexamethasone treatment in each group.The clinical and test data of the three groups were compared. [Results] All patients in the three groups had operation performed successful-ly. The multiple-dose group proved significantly superior to the blank group and single-dose group in terms of consumption of Tramadol[(60.4±13.2) mg vs (90.3±20.3) mg vs (75.4±17.6) mg, P＜0.001] and metoclopramide [(7.7±3.8) mg vs (13.1±5.1) mg vs (10.5±3.1) mg, P＜0.001]. The incidence of perioperative nausea and vomiting was ranked as the multipl-dose group ＜ single-dose group ＜ blank group [cases(%), 3 (8.6) vs 7 (20.0) vs 10 (28.6), P＜0.001]. The ICFS, PSQI and VAS in the three groups were significantly decreased 1 and 3 days aftersurgery compared with those preoperatively (P＜0.05). The multiple-dose group was significantly better than the blank group and singledosegroup regarding PSQI score and VAS score (P＜0.05). In term of blood test, there were no statistically significant differences in WBC,CRP and IL-6 among the three groups before surgery (P＞0.05). However, the multiple-dose group and single-dose group proved significnt-ly superior to the blank group in WBC [(9.7±2.6)×10⁹/L vs (10.5±2.4)×10⁹/L vs (12.8±3.2)×10⁹/L, P＜0.001], CRP [(19.2±6.9) mg/L vs (27.6±8.7) mg/L vs (39.4±10.2) mg/L, P＜0.001] and IL-6 [(32.6±9.6) pg/ml vs (42.8±9.7) pg/ml vs (64.7±11.4) pg/ml, P＜0.001] 3 days postopera-tively. [Conclusion] Multiple administrations of low-dose dexamethasone during perioperative period of femoral intertrochanteric fracturesnot only reduce pain, improve sleep and relieve perioperative fatigue, but also does not increase the risk of hormone-related complications.