Lamadé W R, Friedl W, Schmid B, Meeder P J
Department of Surgery, University of Heidelberg, Germany.
Arch Orthop Trauma Surg. 1995;114(6):335-9. doi: 10.1007/BF00448957.
Bone cement implantation syndrome (BCIS) is characterised by hypotension, hypoxaemia, cardiac arrhythmias, cardiac arrest or any combination of these, leading to death in 0.6-1% of patients. One of the mechanisms suggested to explain these complications is diffuse microembolisation of the lungs as a consequence of extrusion of the bone marrow content by the pressurised bone cement. By reducing intramedullary pressure and changing the operative technique, BCIS can be diminished, but deaths still occur. An anaphylactoid mechanism as a major factor in BCIS is receiving renewed attention since increased plasma histamine levels were recently demonstrated after the implantation of bone cement and a prosthesis. Therefore, we conducted a prospective, randomised study to demonstrate the potential benefit of histamine-receptor-blocking agents in patients undergoing cemented hip arthroplasty. Thirty patients were divided into two groups: group 1, the control group, received no histamine-receptor-blocking agents; group 2, the antihistamine group, received H1 and H2-receptor-blocking agents in standard dosages preoperatively. Both groups were comparable concerning age, sex and physical status (ASA criteria). There was no hospital mortality in either group. Thirteen patients of group 1 demonstrated a sudden fall by more than 10% of their blood pressure, level of PaO2 or both. Fourteen patients of group 2 showed similar changes. The mean decrease of blood pressure in group 1 was 14.6 mmHg (SD 36.8) and in group 2 20.5 mmHg (SD 33.43). The difference is not significant (P = 0.65). The mean decrease of PaO2 in group 1 was 30.5 mmHg (SD 30.5) and in group 2 33.4 mmHg (SD 34.1). The difference is not significant (P = 0.81). Overall, we found even a slight disadvantage for patients receiving antihistamine drugs (statistically not significant). Therefore, histamine-receptor-blocking agents do not have a prophylactic potential in BCIS.
骨水泥植入综合征（BCIS）的特征为低血压、低氧血症、心律失常、心脏骤停或这些情况的任意组合，导致0.6% - 1%的患者死亡。为解释这些并发症而提出的机制之一是，加压骨水泥挤压骨髓内容物导致肺部弥漫性微栓塞。通过降低髓内压力并改变手术技术，BCIS可得到减轻，但仍有死亡发生。由于最近在植入骨水泥和假体后发现血浆组胺水平升高，作为BCIS主要因素的类过敏机制再次受到关注。因此，我们进行了一项前瞻性随机研究，以证明组胺受体阻滞剂对接受骨水泥型髋关节置换术患者的潜在益处。30名患者分为两组：第1组为对照组，未接受组胺受体阻滞剂；第2组为抗组胺组，术前接受标准剂量的H1和H2受体阻滞剂。两组在年龄、性别和身体状况（ASA标准）方面具有可比性。两组均无院内死亡。第1组有13名患者血压、动脉血氧分压（PaO2）水平或两者突然下降超过10%。第2组有14名患者出现类似变化。第1组血压平均下降14.6 mmHg（标准差36.8），第2组为20.5 mmHg（标准差33.43）。差异无统计学意义（P = 0.65）。第1组PaO2平均下降30.5 mmHg（标准差30.5），第2组为33.4 mmHg（标准差34.1）。差异无统计学意义（P = 0.81）。总体而言，我们发现接受抗组胺药物的患者甚至有轻微劣势（统计学上无显著意义）。因此，组胺受体阻滞剂在BCIS中没有预防作用。
