文献类型：期刊文献

中文题名：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

英文题名：A comparison study of general anesthesia and spinal anesthesia in the management of total hip arthroplasty

作者：程浩[1];郭恩琪[2]

机构：[1]绍兴文理学院附属医院麻醉科;[2]浙江省人民医院手外科

年份：2016

卷号：14

期号：5

起止页码：724

中文期刊名：中华全科医学

外文期刊名：Chinese Journal of General Practice

收录：CSTPCD

基金：2014年浙江省医药卫生一般研究计划(2014KYA-011)

语种：中文

中文关键词：全身麻醉;椎管内麻醉;全髋关节置换术;并发症

外文关键词：General anesthesia; Spinal anesthesia; Total hip arthroplasty ; Complications

中文摘要：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(P>0.05)。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,P<0.001];术后麻醉室留观时间显著延长[(16.26±2.44)min vs.(12.98±1.97)min,P<0.001];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。

外文摘要：Objective Both general anesthesia and spinal anesthesia were regularly used in the management of total hip arthroplasty. However, which type of anesthesia was better remained unclear. The present study was to compare the influences of general anesthesia and spinal anesthesia on patients underwent total hip arthroplasty. Method From January, 2008 to October ,2015,584 patients were retrospectively studied. The patients were assigned into general anesthesia group （n = 302） and spinal anesthesia（ n = 282） according to anesthesia methods. The primary outcome measures included rate of any adverse event, deep vein thrombosis, cerebrovascular accident, pulmonary embolism, surgical site infection, urinary tract infection and mortality in the first 28 days. The second outcome measures were rate of tachycardia and hypotension during the operation ,preoperative preparation time, operation time and postoperative room stay time. Result There was no difference between the two groups in gender, age, body mass index and the modified Charlson comorbidity score on admission. When compared with spinal anesthesia group, the patients in general anesthesia group got a significantly longer operation time（99.67±11.60 vs. 92.64± 7.57 min, P 〈 0. 001 ）, a significantly longer postoperative room stay time （ 16.26 ± 2.44 vs. 12.98 ± 1.97 rain, P 〈 0. 001 ）, a significantly higher rate of any adverse event （ 8.28 % vs. 3.90%, P =0. 028） ,a significantly higher rate of hypotension during the operation（29.47% vs. 19.86% ,P =0. 007） ,a signifi- cantly higher rate of deep vein thrombosis （2.65% vs. 0.35% , P = 0. 024） and a higher rate of blood transfusion （ 18.54% vs. 12.06% ,P = 0.03）. Conclusion Spinal anesthesia contributed to lower rate of any adverse event and deep vein thrombosis in the first 28 days. Moreover,lower rate of intraoperative blood transfusion and hypotension,less operation time and postoperative room stay time were observed in spinal anesthesia group as well.