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首页> 外文期刊>Patient Safety in Surgery >Dexamethasone and postoperative hyperglycemia in diabetics undergoing elective hip or knee arthroplasty: a case control study in 238 patients
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Dexamethasone and postoperative hyperglycemia in diabetics undergoing elective hip or knee arthroplasty: a case control study in 238 patients

机译：地塞米松和糖尿病患者行选择性髋关节或膝关节置换术的术后高血糖：238例病例对照研究

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Dexamethasone has been routinely used in the pre-operative setting to enhance analgesia and decrease the incidence of nausea and vomiting in patients undergoing primary arthroplasty. However, dexamethasone has the potential to increase blood glucose levels postoperatively, which is a known risk factor for complications after total joint arthroplasty. The aim of this study was to analyze the effect of dexamethasone administration on post-operative blood glucose levels in diabetic patients after primary hip and knee arthroplasty. This study was a retrospective review of 238 diabetic patients who underwent primary hip and knee arthroplasty between May 1, 2014 and September 30, 2016 at a single urban academic medical center. A total of 77 patients (32.4%) received dexamethasone and 161 (67.7%) did not. Oral hyperglycemic agents were held during the inpatient stay and blood glucose was controlled either with sliding scale insulin or home insulin regimens were continued. All analyses were adjusted for age, BMI, gender, type of diabetes, pre-operative diabetic medication, type of surgical procedure, and pre-operative HgbA1c level. The primary outcome was post-operative hyperglycemia within 72?h of surgery defined as any blood glucose level greater than or equal to 200?mg/dL. Post-operative hyperglycemia was observed in 17.1 and 20.6% of the measurements during the first 24 and 72?h respectively. After controlling for confounding variables, patients who received dexamethasone had 4.07 (95% CI: 2.46, 6.72) and 3.08 (95% CI: 2.34, 4.04) higher odds of post-operative hyperglycemia in the first 24 and 72?h respectively. Dexamethasone administration in diabetic patients undergoing primary arthroplasty increases post-operative hyperglycemia during the first 24 and 72?h. While our data did not investigate causation, dexamethasone use in this patient population should be thoughtfully considered, as post-operative hyperglycemia is a known risk factor for complications.
机译：地塞米松已被常规用于术前设置，以增强镇痛作用并减少初次置换患者的恶心和呕吐的发生率。然而，地塞米松有可能在术后增加血糖水平，这是全关节置换术后并发症的已知危险因素。这项研究的目的是分析地塞米松对糖尿病患者原发髋关节和膝关节置换术后血糖水平的影响。这项研究是对2014年5月1日至2016年9月30日期间在一个城市学术医疗中心接受了原发性髋和膝关节置换术的238例糖尿病患者的回顾性研究。共有77例患者（32.4％）未接受地塞米松治疗，而161例患者（67.7％）未接受地塞米松治疗。住院期间应口服降糖药，并采用滑标胰岛素或继续采用家庭胰岛素治疗来控制血糖。所有分析均根据年龄，BMI，性别，糖尿病类型，术前糖尿病用药，外科手术类型和术前HgbA1c水平进行了调整。主要结果是手术后72小时内的术后高血糖，定义为任何血糖水平大于或等于200 µmg / dL。在开始的24小时和72小时内，分别在测量的17.1和20.6％中观察到术后高血糖。在控制了混杂变量之后，接受地塞米松的患者术后24 h和72 h的高血糖发生几率分别为4.07（95％CI：2.46，6.72）和3.08（95％CI：2.34，4.04）。在进行初次关节置换术的糖尿病患者中，地塞米松的使用在头24和72小时内增加了术后高血糖。尽管我们的数据未调查因果关系，但应考虑考虑在该患者人群中使用地塞米松，因为术后高血糖是已知的并发症危险因素。

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