中国修复重建外科杂志

中国修复重建外科杂志

影响人工全膝关节置换术后血清 IL-6 水平的危险因素分析

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目的 探讨影响人工全膝关节置换术(total knee arthroplasty,TKA)后血清 IL-6 水平的危险因素。 方法 回顾性分析 2015 年 7 月—2017 年 4 月符合选择标准的 273 例初次单侧 TKA 患者的临床资料,其中男 50 例,女 223 例;年龄 36~89 岁,平均 66.3 岁。体质量指数(body mass index,BMI)为(25.5±3.7) kg/m2。骨关节炎 256 例,类风湿性关节炎 17 例。对患者性别、年龄、BMI、病因、是否合并相关内科疾病、术前美国麻醉医师协会(ASA)分级、是否合并膝关节内外翻畸形、膝关节活动度、血清 C 反应蛋白水平、血清 IL-6 水平、手术时间、术中失血量、术后是否使用引流管及尿管、手术当日给予氨甲环酸及地塞米松剂量进行单因素分析,初步筛选 TKA 术后第 1 天血清 IL-6 水平的影响因素;进一步采用多元线性回归模型筛选危险因素。 结果 手术时间(79.7±15.6)min,术中失血量(107.8±25.3)mL。术后使用引流管 111 例,使用尿管 41 例。手术当日静脉应用氨甲环酸(3.2±0.8)g、地塞米松(15.1±6.6)mg,术前及术后第 1、3 天血清 IL-6 水平分别为(4.48±3.05)、(42.65±37.09)、(28.21±26.44)pg/mL。单因素分析结果显示,年龄、病因、术前肺部感染、膝关节活动度、术前血清 C 反应蛋白及 IL-6 水平、手术当日给予氨甲环酸剂量及地塞米松剂量是 TKA 术后第 1 天 IL-6 水平的影响因素(P<0.05),纳入多元线性回归分析。多元线性回归分析结果显示,术前膝关节活动度≤90°、手术当日给予氨甲环酸剂量<3 g、手术当日给予地塞米松剂量<10 mg 是导致 TKA 术后第 1 天血清 IL-6 水平升高的危险因素(P<0.05)。 结论 术前膝关节活动度≤90°、手术当日静脉给予氨甲环酸剂量<3 g 及地塞米松剂量<10 mg 是导致 TKA 术后第 1 天血清 IL-6 水平升高的独立危险因素。

Objective To explore the risk factors associated with interleukin 6 (IL-6) level in serum after total knee arthroplasty (TKA). Methods A retrospective study was made on the clinical data of 273 patients underwent primary unilateral TKA between July 2015 and April 2017. There were 50 males and 223 females with an average age of 66.3 years (range, 36-89 years), and the body mass index (BMI) was (25.5±3.7) kg/m2. Of them, 256 patients suffered with osteoarthritis, and the other 17 patients with rheumatoid arthritis. Univariate analysis was made to find the related factors between IL-6 level in serum at 1 day after operation and preoperative data including gender, age, BMI, diagnosis, comorbidities, preoperative American Society of Anesthesiologists (ASA) grade, preoperative varus or valgus deformity, range of motion of the knee, preoperative level of C-reactive protein (CRP) and IL-6 in serum, operation time, intraoperative blood loss, usage of drainage tube and catheter, and dosage of tranexamic acid and dexamethasone used on day of operation. Furthermore, the multiple linear regression analysis was performed to identify the risk factors. Results The operation time was (79.7±15.6) minutes, and the intraoperative blood loss was (107.8±25.3) mL. Drainage tubes were used in 111 patients and catheters were used in 41 patients after operation. The dosage of tranexamic acid and dexamethasone used on day of operation were (3.2±0.8) g and (15.1±6.6) mg, respectively. The levels of IL-6 in serum were (4.48±3.05), (42.65±37.09), and (28.21±26.44) pg/mL before operation and at 1 and 3 days after operation, respectively. Univariate analysis showed that the level of IL-6 in serum at 1 day after operation was significantly higher in variables as follows: age, diagnosis, history of lung infection, range of motion, preoperative levels of CRP and IL-6 in serum, intravenous dosage of tranexamic acid and dexamethasone on day of operation (P<0.05). Multiple linear regression analysis showed that range of motion less than 90°, intravenous dosage of tranexamic acid on day of operation less than 3 g, and dosage of dexamethasone on day of operation less than 10 mg were significant risk factors (P<0.05). Conclusion Range of motion less than 90°, intravenous dosage of tranexamic acid on day of operation less than 3 g, and dosage of dexamethasone on day of operation less than 10 mg were independent risk factors that resulted in increased level of IL-6 in serum at 1 day after TKA.

关键词: 人工全膝关节置换术; IL-6; 危险因素; 地塞米松; 氨甲环酸

Key words: Total knee arthroplasty; interleukin 6; risk factor; dexamethasone; tranexamic acid

引用本文: 张少云, 曹国瑞, 黄强, 雷一霆, 许宏, 裴福兴. 影响人工全膝关节置换术后血清 IL-6 水平的危险因素分析. 中国修复重建外科杂志, 2018, 32(8): 1001-1005. doi: 10.7507/1002-1892.201712011 复制

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