Department of Joint Surgery and Sports Medicine, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.
Medicine (Baltimore). 2022 Oct 21;101(42):e31223. doi: 10.1097/MD.0000000000031223.
To evaluate the efficacy and safety of dexamethasone (DEXA) combined with tranexamic acid (TXA) in the perioperative period of total hip arthroplasty.
A total of 100 cases were randomly divided into 2 groups (50 cases per group). All patients were given 15 mg/kg TXA before skin incision and 3 hours later. Patients in the intervention group (TXA + DEXA group) were given 20 mg dexamethasone intravenously after the onset of anesthesia, and the same dose of DEXA was administered again 24 hours later. Patients in the placebo group (TXA group) were only given the same dose of normal saline. Postoperative c-reactive protein and interleukin-6, postoperative nausea and vomiting, fatigue visual analogue scale score, postoperative length of stay, range of motion, and consumption of analgesic and antiemetics were statistically analyzed in the 2 groups.
The levels of c-reactive protein and interleukin-6 in the TXA + DEXA group were lower than those in the TXA group at 24, 48, 72 hours post-operatively (P < .001). Walking pain scores in the TXA + DEXA group were also significantly lower than those in the TXA group at 24 and 48 hours (P < .001); rest pain scores were lower at 24 hours (P < .001). Compared with the TXA group, the incidence of nausea VAS, postoperative nausea and vomiting, fatigue, analgesia and antiemetics consumption, postoperative length of stay, and range of motion were lower in the TXA + DEXA group (all P < .05), while there were no significant differences in postoperative hematocrit, total blood loss, and complications (P > .05).
The combination of TXA (15 mg/kg; before skin incision and 3 hours later) and DEX (20 mg dexamethasone intravenously after the onset of anesthesia, and again 24 hours later) is an effective and safe strategy for patients undergoing total hip arthroplasty.
评估地塞米松（DEXA）联合氨甲环酸（TXA）在全髋关节置换术围手术期的疗效和安全性。
将 100 例患者随机分为 2 组（每组 50 例）。所有患者均于切皮前及切皮后 3 小时给予 15mg/kgTXA。干预组（TXA+DEXA 组）患者在麻醉开始时静脉注射 20mg 地塞米松，24 小时后再次给予相同剂量的 DEXA。安慰剂组（TXA 组）仅给予相同剂量的生理盐水。统计分析两组术后 C 反应蛋白和白细胞介素-6、术后恶心呕吐、疲劳视觉模拟量表评分、术后住院时间、活动度以及镇痛药和止吐药的消耗。
术后 24、48、72 小时，TXA+DEXA 组 C 反应蛋白和白细胞介素-6 水平低于 TXA 组（P<0.001）。TXA+DEXA 组术后 24、48 小时行走疼痛评分也明显低于 TXA 组（P<0.001）；休息疼痛评分在 24 小时时较低（P<0.001）。与 TXA 组相比，TXA+DEXA 组恶心 VAS、术后恶心呕吐、疲劳、镇痛和止吐药消耗、术后住院时间和活动度较低（均 P<0.05），而术后血细胞比容、总失血量和并发症无明显差异（P>0.05）。
TXA（15mg/kg；切皮前和切皮后 3 小时）联合 DEX（麻醉开始时静脉注射 20mg 地塞米松，24 小时后再次给予）是全髋关节置换术患者的有效安全策略。
