比较全身麻醉和椎管内麻醉在全髋关节置换术中的临床应用价值

发布时间：2017-12-28 03:20

本文关键词：比较全身麻醉和椎管内麻醉在全髋关节置换术中的临床应用价值　出处：《中华全科医学》2016年05期 　论文类型：期刊论文

【摘要】：目的全髋关节置换术常用的麻醉方式为全身麻醉或椎管内麻醉,哪种麻醉方式更有利于改善患者的临床预后尚未有定论。本研究旨在比较2种麻醉方法对全髋关节置换术患者术后并发症的影响。方法回顾性收集2008年1月—2015年10月全髋关节置换术患者584例,根据术中采用的麻醉方式将患者分为全身麻醉组(n=302)和椎管内麻醉组(n=282)。主要观察指标为28 d内联合并发症发生率、深静脉血栓发生率、心脑血管意外发生率、肺栓塞发生率、手术部位感染发生率、尿道感染率和病死率。次要观察指标为术中心动过速发生率、术中低血压发生率、麻醉室术前准备时间、手术时间和术后麻醉室留观时间。结果 2组患者入院时性别、年龄、BMI和改良Charlson合并症评分差异均无统计学意义(P0.05)。与椎管内麻醉组相比,全身麻醉组患者手术时间显著延长[(99.67±11.60)min vs.(92.64±7.57)min,P0.001];术后麻醉室留观时间显著延长[(16.26±2.44)min vs.(12.98±1.97)min,P0.001];28 d内并发症联合发生率显著增高(8.28%vs.3.90%,P=0.028);术中低血压发生率显著增高(29.47%vs.19.86%,P=0.007);术后深静脉血栓发生率显著增高(2.65%vs.0.35%,P=0.024);输血率显著增高(18.54%vs.12.06%,P=0.03)。结论椎管内麻醉有助于降低全髋关节置换术患者28 d内联合并发症发生率、术后深静脉血栓发生率、输血率、术中低血压发生率、手术时间和术后留观时间。
[Abstract]:Objective the general anesthesia for total hip arthroplasty is general anesthesia or intraspinal anesthesia. Which kind of anesthesia is more conducive to improve the prognosis of patients has not yet been conclusive. The purpose of this study was to compare the effect of 2 anesthetic methods on postoperative complications in patients undergoing total hip replacement. Methods a total of 584 patients undergoing total hip arthroplasty from January 2008 to October 2015 were collected. They were divided into general anesthesia group (n=302) and intraspinal anesthesia group (n=282) according to the anesthesia method adopted during the operation. The main outcome measures included complication rate of 28 d, incidence of deep venous thrombosis, incidence of cardio cerebral vascular accident, incidence of pulmonary embolism, incidence of surgical site infection, urinary tract infection rate and mortality. The secondary observation indexes included the incidence of intraoperative hypotension, the incidence of intraoperative hypotension, preoperative preparation time, operative time and postoperative anesthesia time. Results there was no significant difference in the score of gender, age, BMI and ameliorative Charlson (P0.05) in the 2 groups of patients. Compared with the spinal anesthesia group and general anesthesia group patients were significantly longer [(99.67 + 11.60) min vs. (92.64 + 7.57) min, P0.001]; postoperative anesthesia room time was significantly prolonged [(16.26 + 2.44) min vs. (12.98 + 1.97) min, P0.001]; 28 d in the combined occurrence of complications the rate increased significantly (8.28%vs.3.90%, P=0.028); the incidence of intraoperative hypotension was significantly higher (29.47%vs.19.86%, P=0.007); postoperative deep venous thrombosis incidence increased significantly (2.65%vs.0.35%, P=0.024); blood transfusion rate increased significantly (18.54%vs.12.06%, P=0.03). Conclusion intraspinal anesthesia can help reduce the incidence of complications, the incidence of deep venous thrombosis, blood transfusion rate, intraoperative hypotension, operative time and postoperative observation time in 28 d total hip arthroplasty.
【作者单位】：绍兴文理学院附属医院麻醉科;浙江省人民医院手外科;
【基金】：2014年浙江省医药卫生一般研究计划(2014KYA-011)
【分类号】：R614.2
【正文快照】： 随着人口的老龄化和激素的应用等,髋关节病变发病率越来越高[1]。全髋关节置换术是治疗髋关节病变的主要方法[2-3],据统计全世界范围内每年超过100万例患者需要进行全髋关节置换术[4]。全身麻醉曾被视为全髋关节置换术的金标准,然而近些年来,学者发现椎管内麻醉也可以很好地

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