全身麻醉和椎管内麻醉对全髋关节置换术效果的影响

Comparison of general anesthesia and spinal anesthesia in hip surgery in elderly patients

目的观察全身麻醉和椎管内麻醉对全髋关节置换术效果的影响。方法选取2019年12月1日至2021年12月1日在天长市人民医院接受髋部骨折手术的65岁及以上的72例患者,按照随机数字表法分为全身麻醉组(37例)与椎管内麻醉组(35例),主要指标为是否出现术后60 d内死亡或无法独立行走约3 m,或无法使用助行器或手杖行走;次要结果包括是否出现60 d内死亡、谵妄、出院时间和60 d后的行走能力。结果椎管内麻醉组中有6例(17.1%)患者、全身麻醉组中有7例(18.9%)患者主要指标呈阳性(RR=1.03;95%CI:0.84~1.27;P=0.782)。椎管内麻醉组中有6例(20%)患者、全身麻醉组中有6例(19.4%)患者术后出现新发谵妄(RR=1.04;95%CI:0.84~1.30;P=0.884)。2组其他次要指标结果相似。结论椎管内麻醉用于老年人全髋关节转换术在60 d内的生存率和下床活动方面并不优于全身麻醉,且2种麻醉方式术后谵妄发生率也相似。

Objective To observe the effect of general anesthesia and intraspinal anesthesia in hip surgery in elderly patients.Methods A total of 72 patients aged 65 and over who underwent hip fracture surgery in the People's Hospital of Tianchang from December 1,2019 to December 1,2021 were randomly divided into general anesthesia group(37 cases)and intraspinal anesthesia group(35 cases)according to the method of random number table.The main index was whether there was death within 60 days after operation,or they could not walk about 3 m independently,or they could not walk with walking aids or walking sticks;Secondary outcomes included death within 60 days,delirium,discharge time and walking ability after 60 days.Results There were 6 patients(17.1%)in the intraspinal anesthesia group and 7 patients(18.9%)in the general anesthesia group with positive main indicators(RR=1.03;95%CI:0.84-1.27;P=0.782).There were 6 patients(20%)in the intraspinal anesthesia group and 6 patients(19.4%)in the general anesthesia group who developed new delirium after operation(RR=1.04;95%CI:0.84-1.30;P=0.884).For other secondary indicators,the results of the two groups were similar.Conclusions Intraspinal anesthesia is not superior to general anesthesia in terms of survival rate and recovery of ambulatory activity within 60 days after operation of hip fracture in the elderly,and the incidence of postoperative delirium is similar between the two types of anesthesia.