作　　者： (魏戎）; (武军龙）; (刘营杰）; (石晶）; (王超）; (崔国峰）; (康鹏德）;

机构地区： 郑州大学附属洛阳中心医院骨科,洛阳471000

出　　处： 《中国骨与关节外科》 2017年第2期117-122,共6页

摘　　要： 背景:全身应用糖皮质激素在全膝关节置换术(total knee arthroplasty,TKA)加速康复中的作用尚存争议。目的的:通过系统评价和meta分析的方法评估全身应用糖皮质激素在TKA加速康复中的作用。方法:网络检索英文数据库Pub Med、Ovid、Sciencedirect及中文数据库万方、CNKI,根据纳入、排除标准纳入所有相关的前瞻性随机对照研究,利用Rev Man 5.2软件对所提取数据进行meta分析。结果:共纳入前瞻性随机对照研究8篇(574例TKA)。初步结果显示全身应用糖皮质激素能有效控制TKA术后的炎症因子水平,降低术后恶心呕吐的发生率,减轻患者术后早期疼痛,提高患者满意度。全身应用糖皮质激素可能增加术后第1天的血糖水平,但并不增加术后并发症的发生率。还可能对术后早期血栓标志物水平的控制及膝关节功能康复有一定积极作用。结论:全身应用糖皮质激素可在不增加TKA术后并发症的基础上有效降低术后恶心呕吐的发生率,减轻患者术后早期疼痛,提高患者满意度,对加速康复有重要作用。但仍需更多高质量的研究给出确定性的结论。 Background：The efficacy of systemic steroid for total knee arthroplasty （TKA） is still unclear. Objective：To conduct a systematic review and meta-analysis comparing systemic steroid application in enhanced recovery after surgery （ERAS） for TKA. Methods：Prospective randomized controlled trials（RCT）about systemic steroid administration in TKA were searched in databases of Pubmed, Ovid, Sciencedirect, WanFang and CNKI. Suitable studies were selected according to inclusion and exclusion criteria. The data were extracted and the quality of enrolled studies was evaluated. Meta-analysis was conducted using RevMan5.2 software. Results：Eight literatures involving 574 TKAs were included in this study. Patients who received systemic steroid had a significant reduction in inflammatory factor levels, postoperative nausea and vomiting （PONV） and pain in early postoperative period. Despite systemic steroid increased probably glucose level in the first day after TKA, it did not increase the incidence of complications. Systemic steroid also played a positive role in control of thrombosis markers and functional rehabilitation in early postoperative period. Conclusions： Systemic steroid provides short-term advantages in pain relief and antiemetic effects without sacrificing the safety, which plays an important role in ERAS of TKA. However, more high-quality studies and subsequent meta-analyses are needed.

关 键 词： 糖皮质激素 全膝关节置换 加速康复