23. 静脉注射地塞米松对MIS-TLIF患者的影响

IF 2.5 Q3 Medicine

North American Spine Society Journal Pub Date : 2025-07-01 DOI:10.1016/j.xnsj.2025.100717

Koopong Siribumrungwong MD

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引用次数: 0

摘要

背景：术前先发制人静脉注射地塞米松提高微创经椎间孔腰椎椎体间融合术（MIS-TLIF）术后疗效。主要目的是确定地塞米松是否在不良反应最小的情况下改善术后临床结果，特别是对融合状态的影响。目的评价地塞米松在MIS-TLIF患者中的应用效果。研究设计/设置：双盲随机对照试验。患者样本：每组30例。结果：术后24小时、2周、6周和12周休息和运动时的视觉模拟评分(VAS) -平均吗啡当量消耗-两组之间的副作用（手术部位感染、高血糖、恶心/呕吐）-住院时间- 1年的融合情况。方法因椎管狭窄、腰椎滑脱或椎间盘退变性疾病而接受原发性miss - tlif的患者，随机分为术前静脉注射地塞米松（0.15 mg/kg，最大12 mg）或安慰剂两组。术后评估包括静息和运动时疼痛、吗啡用量、术后恶心、血糖水平、手术部位感染、总住院时间和脊柱融合状态的VAS评分，数据收集至1年。结果共纳入60例患者，每组30例。两组在年龄、性别、诊断、BMI、术前VAS评分（休息和运动）或术前血糖水平方面无显著差异。地塞米松组术后24小时休息时疼痛和运动时疼痛的VAS评分显著降低（p = 0.001），但术后2周至12周无差异。地塞米松组吗啡消耗和恶心明显降低（p = 0.001）。住院时间、手术部位感染、血清葡萄糖水平（p = 0.82）和融合率（两组96.7%,p = 1）无显著差异。结论：与安慰剂相比，miss - tlif患者预防性静脉注射地塞米松可显著减少术后休息和运动时疼痛、吗啡消耗和术后恶心。它具有很高的安全性，不影响聚变状态。FDA器械/药物状态：地塞米松（批准用于此适应症）。

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23. Effects of preemptive intravenous dexamathasone on patients undergoing MIS-TLIF

BACKGROUND CONTEXT

Enhancing postoperative outcomes after minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) using preemptive intravenous dexamethasone administered preoperatively. The primary objective was to determine whether dexamethasone improves postoperative clinical outcomes with minimal adverse effects, particularly on fusion status.

PURPOSE

Evaluate the effects of preemptive dexamethasone on patients undergoing MIS-TLIF procedure.

STUDY DESIGN/SETTING

Double blind RCT.

PATIENT SAMPLE

Thirty in each group.

OUTCOME MEASURES

Postoperative visual analog scale (VAS) scores at rest and during motion at 24 hours, 2 weeks, 6 weeks, and 12 weeks - mean morphine-equivalent consumption - Side effects between the two groups (surgical site infection, hyperglycemia, nausea/vomiting) - Length of stay - Fusion status at 1 year.

METHODS

Patients undergoing primary MIS-TLIF for spinal stenosis, spondylolisthesis, or degenerative disc disease were randomized to receive either preemptive intravenous dexamethasone (0.15 mg/kg, max 12 mg) or placebo preoperatively. Postoperative assessments included VAS scores for pain at rest and during motion, morphine consumption, postoperative nausea, blood glucose levels, surgical site infections, total length of stay, and spinal fusion status, with data collected up to 1 year.

RESULTS

Sixty patients were included in the study, with 30 patients in each group. No significant differences were observed between the two groups regarding age, sex, diagnosis, BMI, preoperative VAS scores (rest and motion), or preoperative blood glucose levels. VAS scores for pain at rest and during motion were significantly lower in the dexamethasone group at 24 hours postoperatively (p = 0.001 for both) but showed no differences from 2 weeks to 12 weeks postoperatively. Morphine consumption and nausea were significantly lower in the dexamethasone group (p = 0.001 for both). Length of stay, surgical site infections, serum glucose levels (p = 0.82), and fusion rates (96.7% in both groups, p = 1) showed no significant differences.

CONCLUSIONS

Preemptive intravenous dexamethasone for patients undergoing MIS-TLIF statistically reduces postoperative pain at rest and during motion, morphine consumption, and postoperative nausea compared to placebo. It demonstrates a high safety profile and does not affect fusion status.