术前应用糖皮质激素对预防全髋关节置换术后直立性低血压疗效的研究

目的评价术前应用甲基泼尼松龙对预防髋关节置换术后直立性低血压的疗效。方法选择2017年5月至2018年6月在武汉大学人民医院行初次单侧髋关节置换患者作为研究对象,将研究对象随机分配至两组,其中实验组32例:术前静脉注射125 mg(2 mL)甲基泼尼松龙;对照组34例:术前注射2 mL生理盐水。术后6 h、24 h指导两组患者根据指定的功能锻炼方案进行锻炼,记录各组间直立性低血压及直立耐受不能发生率及患者活动时血压、心率变化,通过测定C-反应蛋白浓度监测患者系统性炎症反应程度。结果术后6 h实验组及对照组直立性低血压(31.3%、29.4%)及直立耐受不能(28.1%、35.3%)发生率差异无统计学意义(P值分别为0.871、0.532),两组C-反应蛋白浓度差异无统计学意义;术后24 h实验组及对照组直立性低血压(9.4%、20.6%)及直立耐受不能(6.3%、17.6%)发生率差异也无统计学意义(P值分别为0.204、0.260),但实验组C-反应蛋白浓度(25.0±11.3)mg/L明显低于对照组(72.9±23.3)mg/L,差异有统计学意义(P=0.004)。结论与安慰剂组相比,术前大剂量使用糖皮质激素并不能有效降低全髋关节置换术后直立性低血压及直立耐受不能并发症的发生率,但能降低术后系统性炎症反应。

Effect of pre-operative administration of glucocorticoids in the prevention of orthostatic hypotension after total hip arthroplasty

Objective To evaluate the efficacy of pre-operative administration of glucocorticoids in preventing orthostatic hypotension after hip replacement. Methods We included 66 patients who were selected to receive primary unilateral hip replacement in the Renmin Hospital of Wuhan University from May 2017 to June 2018. All the candidates were randomly assigned to either experimental or control group. Each of the patients in the experimental group received 125 mg (2 mL) glucocorticoids pre-operatively. Patients in the control group received 2 mL isotonic saline pre-operatively. At 6h and 24h postoperatively, all subjects in both groups were instructed to follow a standard functional exercise protocol. The incidence of orthostatic hypotension, orthostatic intolerance, variation of blood pressure and heart rate during the mobilization were recorded. The C-reactive protein (CRP) concentration was monitored to show the systemic inflammatory response. Results There was no significant difference of the incidence of both orthostatic hypotension (31.3%, 29.4%) and intolerance (28.1%, 35.3%) between the two groups 6 hours post-operatively (P=0.871, 0.532, respectively). No significant differences in CRP concentrations has been found simultaneously. In the first 24 hours after surgery, the incidence of orthostatic hypotension (9.4%, 20.6%) and intolerance (6.3%, 17.6%) of patients in the tow groups did not differ significantly (P=0.204, 0.260, respectively), but the CRP level was significantly lower (P=0.004) in the experimental group (25.0±11.3) when compared to the control group (72.9±23.3). Conclusion Preoperative high-dose glucocorticoids did not effectively reduce the incidence of orthostatic hypotension and intolerance after total hip arthroplasty when compared to the placebo group, though it reduced the systemic inflammatory response of the patients.