Section for Surgical Pathophysiology 7621, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
The Lundbeck Foundation Centre for Fast-Track Hip and Knee Arthroplasty, Copenhagen, Denmark.
Acta Anaesthesiol Scand. 2018 Aug;62(7):882-892. doi: 10.1111/aas.13108. Epub 2018 Mar 24.
Orthostatic hypotension (OH) and intolerance (OI) are common after total hip arthroplasty (THA) and may delay early mobilization. The pathology of OH and OI includes a dysregulated post-operative vasopressor response, by a hitherto unknown mechanism. We hypothesized that OI could be related to the inflammatory stress response which is inhibited by steroid administration. Consequently, this study evaluated the effect of a pre-operative high-dose methylprednisolone on OH and OI early after THA.
Randomized, double-blind, placebo-controlled study in 59 patients undergoing elective unilateral THA with spinal anesthesia and a standardized multimodal analgesic regime. Patients were allocated (1 : 1) to pre-operative intravenous (IV) methylprednisolone (MP) 125 mg or isotonic saline (C). OH, OI and cardiovascular responses to sitting and standing were evaluated using a standardized mobilization protocol pre-operatively, 6, and 24 h after surgery. Systolic and diastolic arterial pressure and heart rate were measured non-invasively (Nexfin ). The systemic inflammation was monitored by the C-reactive protein (CRP) response.
At 6 h post-operatively, 11 (38%) versus 11 (37%) patients had OH in group MP and group C, respectively (RR 1.02 (0.60 to 1.75; P = 1.00)), whereas OI was present in 9 (31%) versus 13 (43%) patients (RR 0.76 (0.42 to 1.36; P = 0.42)), respectively. At 24 h post-operatively, the prevalence of OH and OI did not differ between groups, though CRP levels were significantly reduced in group MP (P < 0.001).
Pre-operative administration of 125 mg methylprednisolone IV did not reduce OH or OI compared with placebo despite a reduced inflammatory response.
全髋关节置换术后常发生直立性低血压（OH）和不耐受（OI），这可能会延迟早期活动。OH 和 OI 的病理学包括术后血管加压反应失调，其机制尚不清楚。我们假设 OI 可能与炎症应激反应有关，而类固醇的应用会抑制这种反应。因此，本研究评估了术前大剂量甲基强的松龙对全髋关节置换术后早期 OH 和 OI 的影响。
这是一项在 59 例行择期单侧全髋关节置换术的患者中进行的随机、双盲、安慰剂对照研究，患者接受脊柱麻醉和标准化多模式镇痛方案。患者（1：1）分配接受术前静脉注射（IV）甲基强的松龙（MP）125mg 或等渗盐水（C）。使用标准化的活动方案在术前、术后 6 小时和 24 小时评估坐位和站立位时的 OH、OI 和心血管反应。使用 Nexfin 无创测量收缩压和舒张压及心率。通过 C 反应蛋白（CRP）反应监测全身炎症。
术后 6 小时，MP 组和 C 组分别有 11 例（38%）和 11 例（37%）患者发生 OH（RR 1.02（0.60 至 1.75；P = 1.00）），而 OI 分别发生在 9 例（31%）和 13 例（43%）患者中（RR 0.76（0.42 至 1.36；P = 0.42））。术后 24 小时，两组的 OH 和 OI 发生率无差异，但 MP 组的 CRP 水平显著降低（P < 0.001）。
与安慰剂相比，术前静脉注射 125mg 甲基强的松龙并未降低 OH 或 OI，尽管炎症反应有所减轻。
