Objective To explore the safety,efficacy and whether the addition of dexamethasone to a protocol inclu-ding ramosetron further reduces postoperative emesis and whether it reduces postoperative pain after total knee arthro-plasty (TKA).Methods 90 of unilateral TKA were randomly divided into two groups:the Group A(n =45)for all patients undergoing TKA were administrated dexamethasone(10mg)1 h before surgery and ramosetron(0.3mg)im-mediately after surgery;Group B(n =45)were administrated immediately 0.3mg ramosetron through intravenous a-lone postoperatively.It was recorded for the incidence of postoperative nausea and vomiting (PONV),severity of nau-sea and complete response if or not.Patients were assessed 0 to 6,6 to 24,24 to 48,and 48 to 72 h postoperatively. At the same time the VAS scores at the 6,24,48,72 h and KSS scores in the 3,6,12 months postoperation were recor-ded.In addition,patients were evaluated for wound complications and periprosthetic joint infections at a minimum of 1 year after surgery.Results The group A had a lower incidence of PONV during the entire 72h evaluation period and experienced less severe nausea for the first 6 h compared with group B after TKA(P <0.05),although not between 6 to 72 h and there was not difference in other time between the two groups(P >0.05).Patients in the group A experi-enced lower VAS scores at the 24,48h and during the overall study period(P <0.05).No differences were found in wound complications and KSS scores between the groups(P >0.05).Postoperative blood glucose levels were in the normal range between the two groups,incision of all patients healed and each group had no case of periprosthetic joint infection and the other complications in one year postoperation.Conclusions Patients who received prophylactic dexamethasone in addition to ramosetron have reduced postoperative emesis and pain without increasing risks for wound complications,compared with patients who received ramosetron alone in patients after TKA.%目的：探讨术前静脉用小剂量地塞米松对减少单侧全膝关节置换（TKA）术后恶心呕吐及术后早期疼痛的有效性及安全性。方法将90例拟行 TKA 患者随机分为 A 组（45例）与 B 组（45例）。A 组患者于术前1 h 静推地塞米松10 mg，手术完成后立即静推0．3 mg 雷莫司琼；B 组患者仅术后静推同等剂量的雷莫司琼。观察记录：患者术后6、24、48、72 h 的恶心呕吐发生率、严重程度、是否完全缓解，患者术后6、24、48、72h VAS 评分及术后3、6、12个月 KSS 评分，术后手术切口情况及1年内假体感染等并发症。结果A 组患者术后3 d 总的恶心呕吐发生率及0～6 h 恶心呕吐发生率低于 B 组，差异有统计学意义（P ＜0．05），其余时间段恶心呕吐发生率两组差异均无统计学意义（P ＞0．05）。A 组术后24、48 h VAS 评分低于 B 组，差异有统计学意义（P ＜0．05）。术后 KSS 评分两组比较差异无统计学意义（P ＞0．05）。两组患者术后血糖值均在正常范围之内，术后手术切口均一期愈合。术后随访1年均未发生关节感染等并发症。结论单侧 TKA 患者术前预防性静推小剂量地塞米松及术后联合雷莫司琼可以减少术后恶心呕吐及早期疼痛，并不增加手术后相关并发症。
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