麻醉方式对高原大骨节病患者膝关节置换术围术期及预后的影响  

Impacts of Anesthesia Methods on Perioperative Management and Prognosis of Knee Arthroplasty in Patients with Kashin-Beck Disease at High Altitudes

作　　者：邓城旗 黄胜川 孔珍珍 斯朗旺姆 郑向前 尹毅青 Deng Chengqi;Huang Shengchuan;Kong Zhenzhen;Silang Wangmu;Zheng Xiangqian;Yin Yiqing(Department of Anesthesiology,Cancer Institute and Hospital,Tianjin Medical University National Clinical Research Center for Cancer,Tianjin’s Clinical Research Center for Cancer,Tianjin Key laboratory of Cancer Prevention and Therapy,Tianjin 300060,China;Department of Anesthesiology,Tibetan Medical Hospital,Chamdo 854085,China)

机构地区：[1]天津医科大学肿瘤医院麻醉科,国家恶性肿瘤临床医学研究中心,天津市恶性肿瘤临床医学研究中心,天津市肿瘤防治重点实验室,天津300060 [2]昌都市藏医院麻醉科,昌都854085

出　　处：《西藏科技》2025年第1期57-61,80,共6页Xizang Science And Technology

基　　金：天津麻醉科研发展计划项目(TJMZ2022-010);天津市医学重点学科(专科)建设项目(TJYXZDXK-009A)。

摘　　要：目的分析不同麻醉方式对高原大骨节病患者膝关节置换术围术期及预后的影响。方法回顾性分析西藏昌都市藏医院2022年9月至2023年10月大骨节病行全膝关节置换术76例患者的病例资料,男31例,女45例,年龄41~83岁,BMI 17.33~33.73 kg/m^(2),ASA分级Ⅰ~Ⅲ。根据麻醉方式的不同分为两组:全身麻醉组(GA组,n=26)与椎管内麻醉组(IA组,n=50)。收集患者术前基本情况,术前和术中血气分析中pH、PaO_(2)、PaCO_(2)、SaO_(2)值和PaO_(2)变化量,术后1个月膝关节VAS疼痛评分、HSS纽约特种外科医院膝关节评分、并发症等情况。结果与IA组比较,GA组麻醉时间明显延长(P<0.05)。两组术前血气分析(未吸氧)中pH、PaO_(2)、PaCO_(2)和SaO_(2)值差异无统计学意义(P>0.05)。与IA组比较,GA组术中血气分析中pH值明显降低,PaO_(2)、PaCO_(2)、SaO_(2)值明显升高(P<0.05)。GA组术中与术前PaO_(2)变化量为(155.46±78.01)mmHg,明显高于IA组PaO_(2)变化量(35.55±23.19)mmHg(P<0.05)。两组术后1月内膝关节VAS疼痛评分、HSS评分、并发症发生率、病死率差异无统计学意义(P>0.05)。结论与椎管内麻醉相比,全身麻醉可明显提高高原大骨节病膝关节置换术患者围术期氧合情况,但不同麻醉方式对患者术后1月内预后无明显差异。Objective To retrospectively analyze the Impacts of anesthesia methods on perioperative management and prognosis of knee arthroplasty in patients with Kashin-Beck disease at high altitudes.Methods 76 patients with plateau Kashin-Beck disease admitted in the Tibetan Hospital of Changdu from September,2022 to October,2023,including 31 males and 45 females,aged from 41 to 83,with BMI from 17.33 to 33.73 kg/m^(2),and ASA grades fromⅠtoⅢ.The patients were divided into general anesthesia(GA)group(n=26)and intraspinal anesthesia group(IA,n=50)according to different anesthesia methods.The patients'basic preoperative conditions,the values of pH,PaCO_(2),PaO_(2),SaO_(2)and the change of PaO_(2)in preoperative and intraoperative blood gas analyses,and knee VAS scores,HSS scores,and complications in 1 month postoperatively were collected.Results Compared with IA group,the anesthesia time in GA group was significantly prolonged(P<0.05).There was no significant difference in pH,PaO_(2),PaCO_(2)and SaO_(2)between the 2 groups in preoperative blood gas analysis(without oxygen inhalation)(P<0.05).Compared with IA group,pH value in blood gas analysis in GA group was significantly decreased,and PaO_(2),PaCO_(2)and SaO_(2)values were significantly increased(P<0.05).The change of PaO_(2)during and before operation in GA group was(155.46±78.01)mmHg,which was significantly higher than that in IA group(35.55±23.19)mmHg(P<0.05).There was no significant difference in knee pain score,HSS score,complication rate and mortality between the 2 groups within 1 month after surgery(P>0.05).Conclusion Compared with intraspinal anesthesia,general anesthesia can significantly improve the perioperative oxygenation of patients undergoing knee arthroplasty with plateau Kashin-Beck disease,but there was no significant difference in the prognosis of patients within 1 month after surgery among different anesthesia methods.

关 键 词：高原 大骨节病 全身麻醉 椎管内麻醉 

分 类 号：R68[医药卫生—骨科学]