围手术期重复剂量与单剂量地塞米松对全膝关节置换术后疼痛及康复影响的Meta分析

Efficacy of multiple doses and single dose of perioperative dexamethasone on pain and recovery after total knee arthroplasty:a Meta-analysis

目的 系统评价围手术期重复剂量与单剂量地塞米松对全膝关节置换术(TKA)后疼痛及康复的影响。方法 计算机检索PubMed、Embase、Cochrane Library、Web of Science、CNKI、WanFang Data、SinoMed、VIP数据库,搜集关于TKA围手术期重复剂量对比单剂量地塞米松的随机对照试验,检索时限为建库至2024年1月4日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan5.4软件进行Meta分析。结果 共纳入6项研究,包括674例患者,其中单剂量地塞米松组336例和重复剂量地塞米松组338例。Meta分析结果显示,与单剂量地塞米松相比,围手术期重复剂量地塞米松可降低TKA术后48h静息痛评分[SMD=-0.68,95%CI(-1.05,-0.30),P<0.001]、术后48h运动痛评分[SMD=-0.86,95%CI(-1.37,-0.34),P=0.001]、术后48hC-反应蛋白(CRP)水平[MD=-4.43,95%CI(-6.70,-2.16),P<0.001]、术后72h CRP水平[MD=-3.60,95%CI(-5.53,-1.67),P <0.001];2组术后24、72h静息痛评分、术后24、72h运动痛评分、各时段内恶心呕吐发生率、术后24h CRP水平、住院天数、药品不良反应发生率等指标差异均无统计学意义(P>0.05)。5项研究的结果均显示,重复剂量地塞米松组补救性应用镇痛药物剂量或患者比例未增加。结论 现有证据表明,与单剂量地塞米松相比,围手术期重复剂量地塞米松可显著降低TKA术后48h疼痛评分、术后48 h和72 h CRP水平,但未能明显降低术后恶心呕吐发生率和住院天数,也未增加药品不良反应风险。

Objective To systematically review the efficacy of multiple doses and single dose of perioperative dexamethasone on pain and recovery a?ter total knee arthroplasty(TKA).Methods PubMed,Embase,Cochrane Library,Web of Science,CNKI,WanFang Data,SinoMed and VIP databases were electronically searched to collect randomized controlled trials(RCTs) on multiple doses and single dose of dexamethasone during perioperative period of TKA from inception of the databases to January 4,2024.Two reviewers independently screened the literature,extracted data and assessed the risk of bias of the included studies.Meta-analysis was performed by using RevMan 5.4 software.Results A total of 6 studies involving 674 patients were included,336 patients in single dose dexamethasone group and 338 patients in multiple dose dexamethasone group.The results of Meta-analysis showed that compared with single dose of dexamethasone,multiple doses of perioperative dexamethasone could significantly decrease the pain scores at rest at 48h after TKA(SMD=-0.68,95%CI-1.05 to-0.30,P﹤0.001),the pain scores with movement at postoperative 48h(SMD=-0.86,95%CI-1.37 to-0.34,P=0.001),C-reactive protein(CRP) levels at postoperative 48h(MD=-4.43,95%CI-6.70 to-2.16,P ﹤0.001) and CRP levels at postoperative 72h(MD=-3.60,95%CI-5.53 to-1.67,P ﹤0.001).There was no statistically significant difference between the two groups regarding pain scores at rest at postoperative 24 h and 72 h,pain scores with movement at postoperative 24 h and 72 h,incidence of postoperative nausea and vomiting(PONV),CRP levels at postoperative 24 h,length of hospital stay,and incidence of adverse drug reactions(P>0.05).The results of 5 studies showed that multiple doses of dexamethasone did not increase the dosage or patient proportion of remedial analgesics.Conclusion Current evidence shows that compared with single dose of dexamethasone,multiple doses of perioperative dexamethasone can significantly reduce pain scores at postoperative 48h,CRP levels at postoperative 48 and 72h a?ter TKA,but it does not significantly reduce the incidence of PONV,hospital stay,or increase the risk of adverse drug reactions.