本文選題：髖骨折 + 麻醉��； 參考：《北京大學(xué)學(xué)報(bào)(醫(yī)學(xué)版)》2017年06期

【摘要】：目的:比較全身麻醉(general anesthesia,GA)和區(qū)域阻滯麻醉(regional anesthesia,RA)對(duì)接受手術(shù)治療的髖部骨折老年患者術(shù)后心肺并發(fā)癥和住院期間死亡率的影響。方法:回顧性分析我院骨科2005年1月至2014年12月間收治的572例髖部骨折老年患者的臨床資料,分別記錄患者性別、年齡、術(shù)前內(nèi)科合并癥、術(shù)前臥床時(shí)間、骨折原因、手術(shù)和麻醉方法、術(shù)后心肺并發(fā)癥以及住院期間的死亡率。應(yīng)用多重Logistic回歸模型分析不同麻醉方法對(duì)髖部骨折老年患者術(shù)后住院死亡率的影響。結(jié)果:8例老年患者發(fā)生住院期間死亡(8/572,死亡率1.4%),其中RA組5例(5/392,死亡率1.3%),GA組3例(3/180,死亡率1.7%),兩組患者間住院死亡率的差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),多重Logistic回歸分析顯示,性別(OR=0.18,95%CI:0.03~1.05,P=0.057)、年齡(OR=1.22,95%CI:1.07~1.38,P=0.002)、術(shù)前肺部合并癥(OR=12.09,95%CI:2.28~64.12,P=0.003)和手術(shù)方式(OR=9.36,95%CI:1.34~64.26,P=0.024)是術(shù)后發(fā)生住院期間死亡的獨(dú)立危險(xiǎn)因素。36例患者術(shù)后發(fā)生心血管系統(tǒng)并發(fā)癥(36/572,發(fā)生率6.3%),其中RA組19例(19/392,發(fā)生率4.8%),GA組17例(17/180,發(fā)生率9.4%),多重Logistic回歸分析顯示,年齡(OR=1.13,95%CI:1.07~1.19,P0.001)、高血壓(OR=2.72,95%CI:1.24~5.96,P=0.012)和術(shù)前腦血管合并癥(OR=2.11,95%CI:0.99~4.52,P=0.054)是發(fā)生術(shù)后心血管系統(tǒng)并發(fā)癥的獨(dú)立危險(xiǎn)因素。56例患者術(shù)后發(fā)生呼吸系統(tǒng)并發(fā)癥(56/572,發(fā)生率9.8%),其中RA組19例(19/392,發(fā)生率4.8%),GA組37例(37/180,發(fā)生率20.6%),多重Logistic回歸分析顯示,年齡(OR=1.13,95%CI:1.07~1.19,P0.001)、術(shù)前肺部合并癥(OR=2.89,95%CI:1.28~7.05,P=0.020)、術(shù)前臥床時(shí)間(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)是術(shù)后發(fā)生呼吸系統(tǒng)并發(fā)癥的獨(dú)立危險(xiǎn)因素。結(jié)論:RA和GA對(duì)接受手術(shù)治療的髖部骨折老年患者住院期間死亡率無(wú)顯著影響,但RA組患者術(shù)后呼吸系統(tǒng)并發(fā)癥的發(fā)生率低于GA組患者。
[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.
【作者單位】： 北京大學(xué)第三醫(yī)院麻醉科;北京大學(xué)第三醫(yī)院臨床流行病學(xué)研究中心;北京大學(xué)第三醫(yī)院骨科;
【分類號(hào)】：R614

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