摘要
目的回顾性分析不同麻醉方式对创伤骨折患者围术期及转归的影响。方法收集解放军总医院第四医学中心2016年3月-2018年8月创伤骨科收治的肩周骨折及髋部骨折患者699例,依据不同麻醉方式分为全身麻醉(GA)组(n=331)与区域阻滞麻醉(RA)组(n=368),记录患者术前基本情况、术中平均动脉压(MAP)及心率(HR)的变化、出血量、输血量及术后转归等情况。结果两组患者术前合并症Charlson评分比较差异无统计学意义(P>0.05)。与GA组相比,RA组患者年龄较大(P<0.05),所用手术方式多为闭合复位内固定术(P<0.05)。围术期MAP变化情况两组患者相近,差异无统计学意义(P=0.342)。术毕出室前,GA组患者MAP升高,基本恢复至入手术室水平;而RA组患者术毕MAP仍偏低,组间比较差异有统计学意义(P=0.000)。术中GA组患者失血量及输血量均较RA组多,差异有统计学意义(P=0.000)。术毕两组患者入住ICU率、总并发症及病死率比较差异无统计学意义(P>0.05)。但年龄段分析发现,无论接受何种麻醉,患者术后并发症的发生率均随年龄的增长而增高(P<0.05);与GA组相比,RA组≥80岁的患者术后并发症发生率明显降低,差异有统计学意义(P=0.039)。此外,在术前准备时间、手术时间、住院时间及住院费用方面,RA组均低于GA组,差异有统计学意义(P<0.05)。结论总体上不同麻醉方式的创伤骨折患者术后转归无明显差异,但随着年龄增长,术后并发症随之增高;区域阻滞麻醉的优势主要体现在80岁以上的患者。
Objective To retrospectively analyze the effects of anesthesia mode on the perioperative period and postoperative outcome in patients with traumatic fractures.Methods A total of 699 patients with traumatic shoulder fractures and hip fractures,admitted in the Fourth Medical Center of PLA General Hospital from Mar.2016 to Aug.2018,were divided into general anesthesia(GA)group(n=331)and regional block anesthesia(RA)group(n=368)according to different anesthesia mode.The preoperative basic conditions,change rates of intra-operative mean arterial pressure(MAP)and heart rate(HR),amount of blood loss and transfusion,and postoperative outcome were recorded for analyzing whether different anesthesia methods affected the outcome of fracture patients in the real world.Results There was no significant difference in the preoperative comorbidity between the two groups(P>0.05);Compared with the GA group,patients in RA group were older(P<0.05).The surgical procedures were mostly closed reduction and internal fixation(P<0.05).The intra-operative MAP change rate was similar in the two groups(P=0.342);however,the MAP of patients in GA group returned to the level that the patient entered the operative room,while of patients in RA group was still lower,showing statistically significant between the two groups(P<0.001);the intra-operative amount of blood loss and transfusion in GA group was more than those in RA group,showing statistical difference(P=0.000).There was no significant difference between the two groups in postoperative intensive care unit(ICU)rate,total complication and fatality rate(P>0.05),but age analysis indicated that,regardless of the mode of anesthesia,the incidence of postoperative complications increases with age(P<0.05).Compared with GA,patients older than 80 years reduced the incidence of postoperative complications significantly when they chose RA,and the difference was statistically significant(P=0.039).Meanwhile,compared with GA group,patients in RA group was lower and shorter in preoperative time,operative time,length of stay and cost in hospital,showing statistical difference(P<0.05).Conclusions Although there was no significant difference in postoperative outcomes of patients with overall fractures under different anesthesia modes,postoperative complications will increase with age.The advantages of regional block anesthesia are mainly reflected in fracture patients≥80 years.
作者
孟令超
李萌萌
邓城旗
房晓燕
武健
郝薏晴
柳伟伟
李文锋
Meng Ling-Chao;Li Meng-Meng;Deng Cheng-Qi;Fang Xiao-Yan;Wu Jian;Hao Yi-Qing;Liu Wei-Wei;Li Wen-Feng(Postgraduate Training Center of the Fourth Medical Center of PLA General Hospital of Jinzhou Medical University,Beijing 100048;Department of Anesthesiology,the Fourth Medical Center of Chinese PLA General Hospital,Beijing 100048,China;Department of Orthopedics,the Fourth Medical Center of Chinese PLA General Hospital,Beijing 100048,China)
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2020年第4期416-422,共7页
Medical Journal of Chinese People's Liberation Army
基金
国家自然科学基金(30672133)
吴阶平医学基金会临床科研专项资助基金(320.6750.13220)。
关键词
全身麻醉
外周神经阻滞
髋关节骨折
脆性骨折
general anesthesia
peripheral nerve block
hip fracture
fragility fracture
