骨水泥对全髋置换术老年患者应激反应的影响及地塞米松的预防作用

目的:通过观察骨水泥对全髋置换术老年患者应激反应的影响,探讨手术中使用地塞米松对减少骨水泥型髋关节置换术骨水泥反应的临床意义。方法:40例全髋置换术老年患者,随机分为两组:对照组20例,在应用骨水泥前5min加速输液、吸入纯氧;实验组20例,在对照组处理方法的基础上,给予地塞米松10mg静脉滴注。分别于植入骨水泥前5min(T1)、植入后1min(T2)、植入后5min(T3)、植入后10min(T4)抽血测定肾上腺素、去甲肾上腺素和皮质醇浓度,并记录收缩压及心率的变化。结果:与植入骨水泥前5min相比,两组植入后1,5,10min血液中肾上腺素和去甲肾上腺素浓度有不同程度升高(P<0.05或P<0.01),皮质醇在植入后5min有一过性升高(P<0.05);两组间肾上腺素、去甲肾上腺素和皮质醇比较差异无显著性(P>0.05)。与植入骨水泥前5min相比,对照组骨水泥植入后1min及5min收缩压下降,心率增加,差异有显著性(P<0.05或P<0.01),而同时期实验组的收缩压及心率变化并不显著(P>0.05);与对照组同时期相比,实验组收缩压及心率的变化幅度较小(P<0.05或P<0.01)。结论:使用小剂量地塞米松能显著减少骨水泥造成的血流动力学波动,具有一定的临床应用价值。

Effects of bone cement on stress reaction during total hip arthroplasty in elderly patients and prevention effect of dexamethasone

Objective:To observe effects of bone cement on stress reaction during total hip arthroplasty in elderly patients,and investigate prevention effect of dexamethasone.Methods:40 elderly patients with total hip arthroplasty were randomly divided into two groups,20 cases in each group.Transfusion quickly and oxygen were given in control group,and dexamethasone 10 mg was given on the base of control group in experiment group.Adrenalin,noradrenalin,corticosteroid,and systolic blood pressure (SBP),heart rate (HR) were recorded at 5 min before bone cement imbedding,1 min,5 min,and 10 min after bone cement imbedding.Results:Compared with the value at 5 min before bone cement imbedding,adrenalin and noradrenalin at 1 min,5 min after bone cement imbedding increased significantly (P<0.05 or P<0.01),and corticosteroid increased significantly at 5 min after bone cement imbedding (P<0.05).Adrenalin,noradrenalin,corticosteroid in both groups were no difference (P>0.05).Compared with the value at 5 min before bone cement imbedding,SBP increased and HR decreased at 1 min,5 min after bone cement imbedding in control group (P<0.05 or P<0.01).And in the same time,there were no change of SBP and HR in experiment group (P>0.05).Rangeability change of SBP and HR in experiment group was small compared with control group at the same time (P<0.05 or P<0.01).Conclusion:Dexamethasone can keep a balance of haemodynamics resulted by bone cement.