摘要
目的通过meta分析比较区域麻醉(RA)与全身麻醉(GA)对老年患者髋部骨折术后转归的影响。方法在PubMed、Embase、Cochrance Library、WHO国际临床试验注册平台、中国生物医学文献数据库、中国期刊全文数据库和万方医学网检索,检索词:英文为Geriatric、Elderly、Hip fracture、Anesthesia、Nerve block,中文为老年、高龄、髋部骨折、麻醉、神经阻滞。检索策略采用主题词联合自由词,检索时间为2000年1月至2019年4月。RA包括椎管内麻醉(IA)和外周神经阻滞(PNB)。逐步筛选文献、评价质量并提取数据,采用RevMan 5.3软件进行分析。结果最终共纳入25篇文献。与GA比较,采用IA的老年患者髋部骨折术后住院病死率、谵妄、下肢深静脉血栓形成/肺栓塞及脑血管意外发生率降低,住院时间缩短(P<0.05),PNB与GA比较上述指标差异无统计学意义(P>0.05)。2组术后30、90 d和1年病死率、术后肺炎、心肌梗死和肾功能衰竭发生率比较差异均无统计学意义(P>0.05)。结论与GA比较,IA可改善老年患者髋部骨折术后转归。
Objective To systematically compare the effect of regional anesthesia(RA)and general anesthesia(GA)on outcomes following hip fracture in elderly patients.Methods PubMed,Embase,Cochrance Library,WHO International Clinical Trial Register Platform,China Biology Medicine disc,China National Knowledge Infrastructure and Wanfang were searched.The search words were geriatric,elderly,hip fracture,anesthesia,nerve block in English,and aged,advanced age,hip fracture,anesthesia and nerve block in Chinese.The search strategy adopted the subject combined with free word,and the search time was from January 2000 to April 2019.RA included intravertebral anesthesia(IA)and peripheral nerve block(PNB).The literature was gradually screened,the quality was evaluated,and the data were extracted.Meta-analysis was performed using RevMan 5.3 software.Results A total of 25 studies were finally included.Compared with the elderly used GA,the fatality rate and incidence of delirium,deep vein thrombosis/pulmonary embolism,and cerebrovascular accidents were significantly decreased,and the length of hospital stay was shortened in the elderly used IA,and no significant change was found in the parameters mentioned above in the elderly used PNB(P>0.05).There was no significant difference in terms of the fatality rate at 30-day,90-day and 1-year after surgery or incidence of postoperative pneumonia,myocardial infarction and renal failure between the two groups(P>0.05).Conclusion IA can improve the postoperative outcomes of hip fracture when compared with GA in elderly patients.
作者
陈恒利
彭康祖
要亚仙
梁思
潘炫屹
王红杰
Chen Hengli;Peng Kangzu;Yao Yaxian;Liang Si;Pan Xuanyi;Wang Hongjie(Clinical Medical College,Hebei University,Baoding 071000,China;Department of Anesthesiology,Affiliated Hospital of Hebei University,Baoding 071000,China)
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2019年第12期1425-1429,共5页
Chinese Journal of Anesthesiology
基金
2018年河北省财政厅、卫健委资助项目(361007)。
