不同麻醉方法对髋部骨折老年患者术后转归的影响

发布时间：2018-06-17 22:48

本文选题：髋骨折 + 麻醉　；参考：《北京大学学报(医学版)》2017年06期

【摘要】：目的:比较全身麻醉(general anesthesia,GA)和区域阻滞麻醉(regional anesthesia,RA)对接受手术治疗的髋部骨折老年患者术后心肺并发症和住院期间死亡率的影响。方法:回顾性分析我院骨科2005年1月至2014年12月间收治的572例髋部骨折老年患者的临床资料,分别记录患者性别、年龄、术前内科合并症、术前卧床时间、骨折原因、手术和麻醉方法、术后心肺并发症以及住院期间的死亡率。应用多重Logistic回归模型分析不同麻醉方法对髋部骨折老年患者术后住院死亡率的影响。结果:8例老年患者发生住院期间死亡(8/572,死亡率1.4%),其中RA组5例(5/392,死亡率1.3%),GA组3例(3/180,死亡率1.7%),两组患者间住院死亡率的差异无统计学意义(P0.05),多重Logistic回归分析显示,性别(OR=0.18,95%CI:0.03~1.05,P=0.057)、年龄(OR=1.22,95%CI:1.07~1.38,P=0.002)、术前肺部合并症(OR=12.09,95%CI:2.28~64.12,P=0.003)和手术方式(OR=9.36,95%CI:1.34~64.26,P=0.024)是术后发生住院期间死亡的独立危险因素。36例患者术后发生心血管系统并发症(36/572,发生率6.3%),其中RA组19例(19/392,发生率4.8%),GA组17例(17/180,发生率9.4%),多重Logistic回归分析显示,年龄(OR=1.13,95%CI:1.07~1.19,P0.001)、高血压(OR=2.72,95%CI:1.24~5.96,P=0.012)和术前脑血管合并症(OR=2.11,95%CI:0.99~4.52,P=0.054)是发生术后心血管系统并发症的独立危险因素。56例患者术后发生呼吸系统并发症(56/572,发生率9.8%),其中RA组19例(19/392,发生率4.8%),GA组37例(37/180,发生率20.6%),多重Logistic回归分析显示,年龄(OR=1.13,95%CI:1.07~1.19,P0.001)、术前肺部合并症(OR=2.89,95%CI:1.28~7.05,P=0.020)、术前卧床时间(OR=1.11,95%CI:1.04~1.18,P=0.003)和麻醉方法(OR=5.86,95%CI:2.98~11.53,P0.001)是术后发生呼吸系统并发症的独立危险因素。结论:RA和GA对接受手术治疗的髋部骨折老年患者住院期间死亡率无显著影响,但RA组患者术后呼吸系统并发症的发生率低于GA组患者。
[Abstract]:Objective: to compare the effects of general anesthesia (general anesthesia) and regional anesthesia (regional anesthesia) on postoperative cardiopulmonary complications and in-hospital mortality in elderly patients with hip fracture. Methods: the clinical data of 572 elderly patients with hip fracture from January 2005 to December 2014 in our hospital were retrospectively analyzed. The patients' sex, age, preoperative medical complications, preoperative bed rest time and fracture cause were recorded respectively. Surgical and anesthetic procedures, postoperative cardiopulmonary complications, and mortality during hospitalization. Multiple logistic regression model was used to analyze the effect of different anesthetic methods on postoperative hospital mortality of elderly patients with hip fracture. Results 8% of 8 elderly patients died during hospitalization, and the mortality rate was 1.4%. In RA group, 5 cases were 5 / 39 2, 3 cases in GA group were 3 / 180, and 1. 7% in GA group. There was no significant difference in hospital mortality rate between the two groups (P 0.05). Multiple logistic regression analysis showed that there was no significant difference between the two groups. Sex OR0.1895CI0.03: 1.05P0.057, age OR1.2295CI1.07 / 1.38P0.002, preoperative pulmonary complications OR12.0995 / 95CII 2.2864.12P0.003) and operation mode OR9.395CIW 1.3469CIW 1.3464.26P0.024) are independent risk factors for postoperative mortality during hospitalization. 36 cases of postoperative cardiovascular complications occurred 365,572, the incidence of 6.30.33, 19 cases in RA group was 19392,4.839%, 4.895% P 0.024) was an independent risk factor for postoperative mortality during hospitalization. 17 cases in group A (17 / 180), the incidence rate was 9.4%, multiple logistic regression analysis showed that, Age OR1.1395CIW 1.07 1.19% P0.001, Hypertension OR2.72J 95 CI: 1.2472.96P0.012) and preoperative cerebrovascular complications OR2.1195CIW 0.999.52P0.054) are independent risk factors for postoperative cardiovascular system complications. 56 patients have postoperative respiratory complications, with an incidence of 9.80.The RA group (19 cases) has 19 cases of 19392and the incidence rate of 4.895% GA group 37 (P < 0.05) is the independent risk factor for postoperative cardiovascular system complications. The incidence of postoperative respiratory complications in RA group (19 cases) is 19392, and the incidence rate is 4.895% in GA group 37 (P 0.054). The incidence of postoperative respiratory complications in RA group (n = 19) is 19392, and the incidence rate is 4.895% in GA group (n = 37). The incidence rate was 20.6%, and multiple logistic regression analysis showed that, The age of 1.1395 CI: 1.07 / 1.19 / P0.001, preoperative pulmonary complications: 2.899 / 95 CI: 1.287.05 / P 0.020, preoperative bed rest time 1.1195CI1.04 / 1.18P0.003) and anaesthesia method OR5.895CIW 2.9895 / 11.53P0.001) are independent risk factors for postoperative respiratory complications. Conclusion there was no significant difference in the mortality of elderly patients with hip fracture treated by surgery, but the incidence of postoperative respiratory complications in RA group was lower than that in GA group.
【作者单位】：北京大学第三医院麻醉科;北京大学第三医院临床流行病学研究中心;北京大学第三医院骨科;
【分类号】：R614

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