全身麻醉和腰硬联合麻醉对髋部骨折老年病人术后肺部并发症的多因素分析  

Multivariate analysis of postoperative pulmonary complications in elderly patients with hip fracture under general anesthesia and combined spinal-epidural anesthesia

作　　者：刘鹏 卢胜 彭刚 LIU Peng;LU Sheng;PENG Gang(Department of Anesthesiology,Shenzhen Integrated traditional Chinese and Western Medicine Hospital,Shenzhen,Guangdong,518100,China)

机构地区：[1]深圳市中西医结合医院麻醉科,广东深圳518100

出　　处：《新疆医学》2022年第3期308-310,314,共4页Xinjiang Medical Journal

摘　　要：目的 分析全身麻醉和腰硬联合麻醉对髋部骨折老年病人术后肺部并发症的相关影响因素。方法 研究对象为本院在2019年7月至2020年7月时间段中收治的230例手术治疗的髋部骨折老年患者,对其临床资料进行回顾性分析,根据其麻醉方式的不同将其分为A组和B组,A组采用全身麻醉(n=80),B组采用腰硬联合麻醉(n=150),对两组患者的手术治疗情况以及肺部并发症发生率进行比较,同时根据其有无发生肺部并发症对可能影响其发生肺部并发症的相关影响因素进行分析。结果 A组患者的手术时间和出血量与B组比较,差异均无统计学意义(P> 0.05)。A组患者肺部并发症发生率明显高于B组,差异有统计学意义(P <0.05)。性别、ASA分级、心血管疾病以及糖尿病和患者术后肺部并发症的发生无明显关系(P> 0.05),年龄、手术时长、麻醉方式以及术前卧床时间和患者术后肺部并发症的发生存在明显关系(P <0.05)。多因素Logistic回归分析结果显示影响患者术后发生肺部并发症的独立危险因素为年龄、手术时长、麻醉方式以及术前卧床时间(P <0.05)。结论 对于髋部骨折老年患者,在麻醉方案选择上,全身麻醉术后发生肺部并发症的风险要高于腰硬联合麻醉,另外年龄、手术时长以及术前卧床时间也是导致患者术后发生肺部并发症的独立危险因素。Objective To analyze the related factors of general anesthesia and combined lumbar and epidural anesthesia on postoperative pulmonary complications in elderly patients with hip fracture. Methods 230 cases of elderly patients who underwent surgical treatment of hip fractures in the hospital from July 2019 to July 2020 were selected as research subjects. The clinical data were retrospectively analyzed. All cases were divided into group A and group B according to the different methods of anesthesia. Group A were treated with general anesthesia(n = 80), while group B were received waist hard joint anesthesia(n = 150). Surgical treatment and the incidence of pulmonary complications were compared between the two groups, and the related factors that might influence the occurrence of pulmonary complications were analyzed. Results There were no significant differences in operation time and blood loss between group A and group B(P > 0.05). The incidence of pulmonary complications in group A was significantly higher than that in group B, with statistical significance(P < 0.05). Gender, ASA grade, cardiovascular disease and diabetes had no significant relationship with the occurrence of postoperative pulmonary complications(P > 0.05), while age, operation duration, anesthesia mode and preoperative bed time had significant relationship with the occurrence of postoperative pulmonary complications(P < 0.05). Multivariate Logistic regression analysis showed that the independent risk factors influencing postoperative pulmonary complications were age, operation duration, anesthesia method and preoperative bed time(P < 0.05). Conclusion For elderly patients with hip fracture, the risk of pulmonary complications after general anesthesia is higher than that after combined lumbar and epidural anesthesia in terms of anesthesia plan selection. In addition,age, operation time and preoperative bed time are independent risk factors for postoperative pulmonary complications.

关 键 词：髋部骨折 老年 全身麻醉 肺部并发症 腰硬联合麻醉 影响因素 

分 类 号：R614[医药卫生—麻醉学]