Chen Jiazheng, Wang Cheng, Li Feng, Wang Xinguang, Li Yang, Feng Hui, Zhao Minwei, Tian Hua
Department of Orthopaedics/Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education/Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China.
Orthop Surg. 2025 Mar;17(3):814-821. doi: 10.1111/os.14333. Epub 2025 Jan 28.
With the global aging population, the incidence of OA is rising annually, and the number of TKA surgeries is rapidly increasing, placing a heavy economic and healthcare burden on society. As one of the key medications in the ERAS protocol, DXM can significantly reduce postoperative pain, suppress nausea and vomiting, and accelerate patient recovery. However, the safety of perioperative DXM use in patients with diabetes remains unclear. This study aims to clarify the safety of perioperative DXM application in diabetic patients.
This retrospective analysis involved 285 patients with type 2 diabetes and late-stage knee osteoarthritis who underwent unilateral TKA at the Joint Surgery Center of Peking University Third Hospital from January 2019 to November 2022. After application of the inclusion and exclusion criteria, 161 patients were included in the study. The patients were divided into two groups according to whether they had received continuous intravenous administration of DXM for 3 days postoperatively: the DXM group (n = 66) and the non-DXM group (n = 95). All other treatments and medications were the same in both groups. The patients' PBG, incidence of PONV, length of hospital stay, pain scores, and clinical data were collected and compared between the two groups.
There were no significant differences in the general preoperative data between the DXM and non-DXM groups. The average PBG and the proportion of patients with levels exceeding 200 mg/dL were not significantly different between the two groups (10.84 mg/dL vs. 11.05 mg/dL and 43.2% vs. 43.9%). The postoperative visual analog scale scores (3.67 vs. 2.48) and the incidence of PONV were significantly lower in the DXM than non-DXM group (40% vs. 16%). The preoperative level of glycated hemoglobin accurately predicted PBG. Furthermore, there were no statistically significant differences in the incidence of early postoperative complications between the groups.
The administration of DXM after unilateral TKA can effectively reduce postoperative pain and suppress the occurrence of PONV without affecting PBG in patients with type 2 diabetes. In addition, the preoperative level of glycated hemoglobin can accurately predict PBG.
随着全球人口老龄化，骨关节炎（OA）的发病率逐年上升，全膝关节置换术（TKA）手术数量迅速增加，给社会带来了沉重的经济和医疗负担。作为加速康复外科（ERAS）方案中的关键药物之一，地塞米松（DXM）可显著减轻术后疼痛、抑制恶心和呕吐，并加速患者康复。然而，糖尿病患者围手术期使用DXM的安全性仍不明确。本研究旨在阐明糖尿病患者围手术期应用DXM的安全性。
本回顾性分析纳入了2019年1月至2022年11月在北京大学第三医院关节外科中心接受单侧TKA的285例2型糖尿病合并晚期膝关节骨关节炎患者。应用纳入和排除标准后，161例患者纳入研究。根据术后是否连续静脉输注DXM 3天，将患者分为两组：DXM组（n = 66）和非DXM组（n = 95）。两组的所有其他治疗和药物均相同。收集并比较两组患者的餐后血糖（PBG）、恶心呕吐发生率、住院时间、疼痛评分及临床资料。
DXM组和非DXM组术前一般资料无显著差异。两组的平均PBG及水平超过200 mg/dL的患者比例无显著差异（10.84 mg/dL对11.05 mg/dL，43.2%对43.9%）。DXM组术后视觉模拟量表评分（3.67对2.48）及恶心呕吐发生率显著低于非DXM组（40%对16%）。术前糖化血红蛋白水平可准确预测PBG。此外，两组术后早期并发症发生率无统计学显著差异。
单侧TKA术后给予DXM可有效减轻术后疼痛并抑制恶心呕吐的发生，且不影响2型糖尿病患者的PBG。此外，术前糖化血红蛋白水平可准确预测PBG。
