不同麻醉方法对髋部骨折老年患者术后转归的影响

Abstract

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(P＞0.05),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,P＜0.001)、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,P＜0.001)、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,P＜0.001)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.

Objective:To investigate the effect of general or regional anesthesia on postoperative cardiopulmonary complications and inpatient mortality after hip fracture surgery in elderly patients.Methods:A retrospective analysis was conducted according to the medical records of 572 elderly patients with hip fractures admitted to our hospital from January 1,2005 to December 31,2014.The age,gender,preoperative comorbidities,length of preoperative bedridden time,mechanism of injury,surgical types,anesthetic methods,major postoperative complications and inpatient mortality were recorded.Multivariate Logistic regression analysis was applied to analyze the impact of different anesthetic methods on inpatient mortality in these patients.Results:Of the 572 patients,392 (68.5％) received regional anesthesia.Inpatient death occurred in 8 (8/572,mortality:1.4％),including 5 cases of RA group (5/392,mortality:1.3％) and 3 cases of GA group (3/180,mortality:1.7％).There was no statistically significant difference between the two groups in inpatient mortality (P ＞ 0.05).Multiple Logistic regression analysis showed that gender (odds ratio:0.18,95％ CI:0.03-1.05,P =0.057),age (odds ratio:1.22,95％ CI:1.07-1.38,P =0.002),preoperative pulmonary comorbidities (odds ratio:12.09,95％ CI:2.28-64.12,P =0.003) and surgical types (odds ratio:9.36,95％ CI:1.34-64.26,P =0.024) were risk factors for inpatient mortality.Postoperative cardiovascular complications occurred in 36 patients (36/572,morbidity:6.3％),with 19 patients in RA group (19/392,morbidity:4.8％),and 17 patients in GA group (17/180,morbidity:9.4％).Multiple Logistic regression analysis showed that age (odds ratio:1.13,95％ CI:1.07-1.19,P ＜ 0.001),hypertension (odds ratio:2.72,95％ CI:1.24-5.96,P =0.012) and preoperative cerebral comorbidities (odds ratio:2.11,95％ CI:0.99-4.52,P =0.054) were risk factors for postoperative cardiovascular complications.Postoperative pulmonary complications occurred in 56 patients (56/572,morbidity:9.8％),with 19 patients in RA group (19/392,morbidity:4.8％),and 37 patients in GA group (37/180,morbidity:20.6％).Multiple Logistic regression analysis showed that age (odds ratio:1.13,95％ CI:1.07-1.19,P ＜0.001),preoperative pulmonary comorbidities (odds ratio:2.89,95％ CI:1.28-7.05,P=0.020),length of preoperative bedridden time (odds ratio:1.11,95％ CI:1.04-1.18,P =0.003) and anesthetic methods (odds ratio:5.86,95％ CI:2.98-11.53,P ＜ 0.001) were risk factors for postoperative pulmonary complications.Conclusion:General anesthesia may not affect the inpatient mortality after hip fracture surgery in elderly patients.Regional anesthesia is associated with a lower risk of pulmonary complications after surgical procedure compared with general anesthesia.