地塞米松对老年肱骨近端骨折术后早期的影响

Effect of dexamethasone on the early postoperative period of proximalhumeral fractures in the elderly

目的 探讨老年肱骨近端骨折术后单次应用小剂量地塞米松的临床疗效及安全性。方法 选取2021年4月至2022年4月于该院行肱骨近端骨折切开复位钢板螺钉内固定手术治疗的老年患者,将符合标准的120例患者分为2组,每组60例。地塞米松组术后1~2 h静脉注射10 mg地塞米松,安慰剂组注射等量的生理盐水。比较2组患者术前及术后24、48 h及7 d时静息状态及活动状态的视觉模拟评分法(VAS)评分、肩关节日本骨科协会评估治疗评分(JOA评分)、炎症指标水平、恶心呕吐发生率、住院时间、患者满意度及术后伤口并发症。结果 地塞米松组术后24、48 h及7 d时活动状态下的VAS评分及肩关节JOA评分明显优于安慰剂组,差异有统计学意义(P<0.05)。地塞米松组术后24、48、72 h的白细胞介素-6(IL-6)、C反应蛋白(CRP)水平均明显低于安慰剂组,差异有统计学意义(P<0.05)。地塞米松组平均住院时间较安慰剂组缩短1.8 d,术后地塞米松组恶心呕吐发生率明显低于安慰剂组,差异均有统计学意义(P<0.05)。术后2组患者均获得良好的满意度,且差异无统计学意义(P>0.05)。2组患者出院时伤口均无红肿、渗液及感染等并发症。结论 术后单次静脉应用小剂量地塞米松可明显缓解老年肱骨近端骨折术后疼痛,降低炎症因子水平,缩短住院时间,降低术后恶心呕吐发生率,且不增加伤口感染等并发症。

Objective To investigate the clinical effect and safety of a single low-dose postoperative dexamethasone after operation of proximal humeral fracture in elderly patients.Methods From April 2021 to April 2022,a total of 120 elderly patients who received open reduction plate screw internal fixation for proximal humeral fractures in this hospital were randomly divided into two groups.At 1-2 h postoperatively,the patients in the dexamethasone group received a single dose of 10mg dexamethasone intravenously,while those in the placebo group received the same amount of normal saline.The visual analogue scale(VAS)score of resting state and active state,JOA score of shoulder joint evaluation and treatment,inflammatory index level,incidence of nausea and vomiting,hospitalization time,patient satisfaction and postoperative wound complications were compared between the two groups.Results The VAS score and JOA score of shoulder joint in dexamethasone group at 24 h,48 h and 7 d after operation,VAS score and JOA score of shoulder joint in dexamethasone group were significantly better than those in the placebo group(P<0.05).The average hospitalization time in dexamethasone group was 1.8 d,shorter than that in placebo group,and the incidence of nausea and vomiting in the dexamethasone group was significantly lower than that in the placebo group after operation,with statistical significance(P<0.05).Patients in both groups obtained good satisfaction after operation,and the difference was not significant(P>0.05).Furthermore,there were no incidence of wound healing such as redness,swelling,exudation and infection in both groups(P>0.05).Conclusion Single low-dose dexamethasone postoperatively can obviously relieve postoperative pain,reduce inflammatory factors,shorten hospitalization time,reduce postoperative nausea and vomiting,and do not increase complications such as wound infection.