不同麻醉方式与老年患者髋关节置换术后转归的相关性

Correlation between different anesthesia methods and outcomes after hip replacement in elderly patients

目的比较不同麻醉方式对老年患者髋关节置换术后转归的影响。方法回顾性分析2012年12月至2018年10月行髋关节置换术患者566例,年龄≥75岁,根据麻醉方式分为两组:全身麻醉组(G组,n=233)和蛛网膜下腔阻滞组(S组,n=333)。采用倾向评分将患者按1∶1匹配,得到组间协变量均衡样本。比较两组术中情况、术后并发症、转入ICU例数和住院时间。结果对患者一般资料进行匹配后,G组和S组各纳入患者225例。与G组比较,S组手术时间、麻醉时间、手术室停留时间明显缩短,心血管并发症、肺部感染、深静脉血栓形成/肺栓塞、术后谵妄、术后恶心呕吐、转入ICU率明显降低,住院时间明显缩短,术后头痛、尿潴留发生率明显升高(P<0.05)。结论对于老年髋关节置换术患者,蛛网膜下腔阻滞可以改善术后转归,加速术后康复进程。

Objective To compare the effects of different anesthetic types on perioperative outcomes in elderly patients undergoing total hip replacement.Methods The demographic,perioperative data of the 566 patients,aged≥75 years,who underwent total hip replacement between December 1,2012 and October 31,2018,were retrospectively evaluated.The patients were divided into general anesthesia group(group G,n=233)and spinal anesthesia group(group S,n=333).One-to-one propensity score matching(PSM)was performed to balance the covariance between group G and group S.The operative parameters,postoperative complications,rates of ICU use,and length of hospital stay between the two groups were compared.Results After matching the general data of the patients,225 patients were included in each group.Compared with group G,the duration of anesthesia,operation,and operate room stay times were significantly decreased,the rates of cardiovascular complications,pulmonary infection,deep venous thrombosis/pulmonary embolism,postoperative delirium,postoperative nausea and vomiting,postoperative headache and urinary retention were decreased,and hospital stay was shorter in group S(P<0.05).However,the probability of postoperative headache and postoperative urinary retention in group S was significantly higher than that in group G(P<0.05).Conclusion Compared to general anesthesia,spinal anesthesia improved perioperative outcomes in elderly patients undergoing total hip replacement.