关节置换手术老年患者围手术期的激素应用效果研究

The the clinical effects of perioperative application of low dose glucocorticoid in the treatment of elderly patients with joint replacement

目的：研究糖皮质激素在老年患者围手术期应用的临床疗效及安全性。方法：选取90例行关节置换术的老年患者,随机分为对照组与观察组,每组45例。观察组术中给予地塞米松10mg,术后1-3d,每天5mg;对照组术中给予10mg生理盐水,术后1-3d,每天给予5mg生理盐水。观察并记录两组患者术后静息痛VA评分、血清白蛋白、空腹血糖、静脉血C-反应蛋白（CRP）水平及髋膝关节Harris、HSS评分;记录两组患者术后并发症发生情况。结果：观察组患者术后第1、3天VAS评分均小于对照组（P〈0.05）;术后第1、3天血清白蛋白、空腹血糖、CRP等血清指标两组患者比较均无统计学差异（P〉0.05）;观察组患者术后第7天髋、膝关节评分均优于对照组（P〈0.05）;两组患者术后均未发生切口感染、愈合较差等并发症。结论：老年患者关节置换术围手术期应用小剂量糖皮质激素能够提高临床疗效,且不增加激素并发症发生率,安全性好。

Objective：To explore the clinical effects of perioperative application of low dose glucocorticoid in the treatment of elderly patients with joint replacement.Methods：90elderly patients with joint replacement were randomly divided into control group and observation group,45 cases in each group.Observation group patients were given dexamethasone 10 mg,after surgey 1to 3d,5mg per day;the control group patients were given 10 mg saline,5mg,1to 3days after surgery.Observed and recorded rest pain VAS score,serum albumin,fasting glucose,blood levels of C-reactive protein and hip and knee Harris,HSS score;record the incidence of postoperative complications in patients.Results：VAS scores of 1、3dof the observation group were lower than the control group（P〈0.05）;serum albumin,fasting blood glucose,serum CRP of two groups showed no significant difference（P〈0.05）;the7th day of hip and knee scores of the observation group were better than the control group（P〈0.05）;the postoperative wound infection occurred were healing complications such as poor,with good security.Conclusion：perioperative application of low dose glucocorticoid in the treatment of elderly patients with joint replacement can improve the clinical efficacy,without increasing the incidence of complications hormones,with good security.