循证医学：围手术期全身地塞米松可缩短全关节置换术的住院时间

来源：304关节学术

Perioperative Systemic Dexamethasone Reduces Length of Stay in Total Joint Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

围手术期全身地塞米松可缩短全关节置换术的住院时间：

随机对照试验的系统回顾和荟萃分析

译者：沈松坡

BACKGROUND: The objective of this review is to examine the effect of perioperative systemic corticosteroids at varying doses and timings on early postoperative recovery outcomes following unilateral total knee and total hip arthroplasty. The primary outcome was length of stay (LOS).

背景:本综述的目的，是研究单侧全膝关节和全髋关节置换术前全身应用糖皮质激素不同剂量和给药时间的对术后早期恢复的影响。主要结果是住院时间(LOS)。

METHODS: A systematic review and meta-analysis of randomized controlled trials was performed. MEDLINE, EMBASE, and Cochrane Library databases were searched from inception to June 1, 2020. Studies comparing the outcome of adult patients receiving a systemic steroid to patients who did not receive steroids were included.

方法:对随机对照试验进行系统回顾和荟萃分析。检索MEDLINE、EMBASE和Cochrane图书馆数据库从建立伊始到2020年6月1日的数据。比较接受全身类固醇治疗的成年患者与未接受糖皮质激素治疗的患者预后的研究也包括在内。

RESULTS: Seventeen studies were included, incorporating 1957 patients. Perioperative corticosteroids reduced hospital LOS (mean difference [MD] = -0.39 days, 95% confidence interval [CI] -0.61 to -0.18). A subsequent dose of corticosteroid at 24 hours further reduced LOS (MD = -0.33, 95% CI -0.55 to -0.11). Corticosteroids resulted in reduced levels of pain on postoperative day (POD) 0 (MD = -1.99, 95% CI -3.30 to -0.69), POD1 (MD = -1.47, 95% CI -2.15 to -0.79), and POD2. Higher doses were more effective in reducing pain with activity on POD0 (P = .006) and 1 (P = .023). Steroids reduced the incidence of PONV on POD1 (log odds ratio [OR] = -1.05, 95% CI -1.26 to -0.84) and POD2, with greater effect at higher doses (P = .046). Corticosteroids did not increase the incidence of infection (P = 1.000), venous thromboembolism (P = 1.000), or gastrointestinal hemorrhage (P = 1.000) but were associated with an increase in blood glucose (MD = 5.30 mg/dL, 95% CI 2.69-7.90).

结果: 共纳入17项研究，1957名患者。围手术期糖皮质激素降低了医院的LOS(平均差异[MD] = -0.39天，95%置信区间[CI] -0.61至-0.18)。随后24小时服用糖皮质激素进一步降低了LOS (MD = -0.33, 95% CI -0.55至-0.11)。皮质类固醇可降低术后第一天(POD) 0 (MD = -1.99, 95% CI -3.30至-0.69)、POD1 (MD = -1.47, 95% CI -2.15至-0.79)和POD2的疼痛水平。较高的剂量在减少疼痛与活动的POD0 (P = .006)和1 (P = .023)更有效。糖皮质激素降低了POD1 (log odds ratio [OR] = -1.05, 95% CI -1.26至-0.84)和POD2上的PONV发病率，在高剂量下效果更明显(P = .046)。糖皮质激素不会增加感染(P = 1.000)、静脉血栓栓塞(P = 1.000)或胃肠道出血(P = 1.000)的发生率，但与血糖升高有关(MD = 5.30 mg/dL, 95% CI 2.69-7.90)。

CONCLUSION: Perioperative corticosteroids are safe, facilitate earlier discharge, and improve patient recovery following unilateral total knee arthroplasty and total hip arthroplasty. Higher doses (15-20 mg of dexamethasone) are associated with further reductions in dynamic pain and PONV, and repeat dosing may further reduce LOS.

结论:单侧全膝关节置换术和全髋关节置换术围手术期使用糖皮质激素是安全的，有利于早期出院，并能促进患者的康复。高剂量(15-20毫克地塞米松)可进一步减少动态疼痛和PONV，重复给药可进一步减少LOS。

文献出处：Lex JR, Edwards TC, Packer TW, Jones GG, Ravi B. Perioperative Systemic Dexamethasone Reduces Length of Stay in Total Joint Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Arthroplasty. 2020 Oct 16:S0883-5403(20)31089-5. doi: 10.1016/j.arth.2020.10.010. Epub ahead of print. PMID: 33190999.