麻醉方式选择对髋部骨折患者预后的影响  

The influence of type of anesthesia selection on the prognosis of hip fractures

作　　者：王晓伟[1] 杨红梅[1] 高杰[1] 征华勇 刘智 孙天胜 Wang Xiaowei;Yang Hongmei;Gao Jie;Zheng Huayong;Liu Zhi;Sun Tiansheng(Department of Orthopaedics,7th Medical Center,General Hospital of the Chinese People's Liberation Army,BeiJing 100700,China)

机构地区：[1]中国人民解放军总医院第7医学中心骨科,北京100700

出　　处：《中华老年骨科与康复电子杂志》2025年第1期39-45,共7页Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition)

基　　金：全军后勤科研重点项目(BLJ18J006);北京市科技新星计划专项(Z181100006218031)。

摘　　要：目的比较不同麻醉方式对髋部骨折预后的影响。方法回顾性分析2012年1月至2019年12月我院1177例髋部骨折资料,男性377例,女性800例,平均年龄(80.10±8.41)岁。根据麻醉方式将患者分为全身麻醉(337例)、椎管内麻醉(614例)和神经阻滞麻醉(226例);比较三组患者术后死亡率、并发症、疼痛程度。结果神经阻滞麻醉术后30天、1年、整体死亡率最高,依次为椎管内麻醉和全身麻醉,但调整多种混淆因素后,三组患者术后死亡风险无统计学差异。全身麻醉术后谵妄、脑血管并发症和静脉血栓发生率高,而神经阻滞麻醉心脏并发症率高,调整多种混淆因素后,椎管内麻醉(OR=0.344,95%CI:0.203,0.550,P=0.000)和神经阻滞(OR=0.527,95%CI:0.274,0.912,P=0.045)是术后谵妄、恶心和呕吐的保护因素,椎管内麻醉是术后脑血管并发症(OR=0.456,95%CI:0.250,0.830,P=0.010)和静脉血栓(OR=0.386,95%CI:0.210,0.710,P=0.002)的保护因素。术后不同时间段,疼痛程度有统计学差异(P<0.05),不同麻醉方式,疼痛程度有统计学差异(P<0.05)。结论麻醉方式对髋部骨折术后死亡风险影响不明显,但全身麻醉可增加术后谵妄、恶心和呕吐率,术后早期疼痛程度更重,而椎管内麻醉术后不容易发生脑血管并发症和静脉血栓。Objective To compare the effects of different anesthesia methods on the prognosis of hip fractures.Methods A retrospective analysis was conducted on 1177 cases of hip fractures in our hospital from January 2012 to December 2019,377 males and 800 females,with an average age of(80.10±8.41)years.Patients were divided into general anesthesia(337 cases),spinal anesthesia(614 cases),and nerve block anesthesia(226 cases)based on the anesthesia method.The postoperative mortality rate,complications,and pain level of the three groups of patients were compared.Results The highest overall mortality rates were observed 30 days,1 year,and after nerve block anesthesia,followed by spinal anesthesia and general anesthesia.However,after adjusting for multiple confounding factors,there was no statistically significant difference in the risk of postoperative death among the three groups of patients.The incidence of postoperative delirium,cerebrovascular complications,and venous thrombosis is high under general anesthesia,while the incidence of cardiac complications under nerve block anesthesia is high.After adjusting for various confounding factors,spinal anesthesia and nerve block are protective factors for postoperative delirium,nausea,and vomiting,while spinal anesthesia is a protective factor for postoperative cerebrovascular complications and venous thrombosis.There were statistically significant differences in pain levels at different time periods after surgery(P<0.05),and there were statistically significant differences in pain levels under different anesthesia methods(P<0.05).Conclusions The impact of anesthesia methods on the risk of postoperative death in hip fractures is not significant,but general anesthesia can increase the rates of postoperative delirium,nausea,and vomiting.Early postoperative pain is more severe,while spinal anesthesia is less prone to cerebrovascular complications and venous thrombosis after surgery.

关 键 词：髋部骨折 麻醉 死亡 

分 类 号：R61[医药卫生—外科学]