不同麻醉方式对全膝关节置换围术期失血量及术后并发症的影响

Effect of Different Anesthesia Modalities on Perioperative Blood Loss and Postoperative Complications in Total Knee Arthroplasty

目的本研究主要评价不同麻醉方式,即腰硬联合麻醉和全身麻醉对初次单侧全膝关节置换术(total knee arthroplasth,TKA)患者围术期失血量和术后并发症的影响。方法收集2015年1月至2019年12月于河南省洛阳正骨医院接受初次单侧TKA的3568例患者病历资料进行回顾性分析,腰硬联合麻醉组966例,其中男210例,女756例;年龄45~85岁,平均(66.69±7.70)岁;全身麻醉组2602例,其中男597例,女2005例;年龄46~85岁,平均(66.63±7.56)岁。比较两组患者的一般基线指标(诊断、并存疾病、血容量、术前血红蛋白、术前血细胞比容、手术侧别、手术时间等),分析两组患者围术期总失血量、术中失血量、异体输血率、引流量、血红蛋白和血细胞比容变化量等,并记录患者术后并发症(包括深静脉血栓、肺栓塞、恶心呕吐、电解质紊乱等)的发生情况,最后评估两组患者术后住院天数、术后1个月膝关节活动度等康复指标及住院治疗费用等。结果腰硬联合麻醉组的围术期总失血量、血红蛋白最大变化量及血细胞比容最大变化量分别为(743.67±546.36)mL、(27.94±17.85)g/L、(0.14±0.05)L/L,全身麻醉组分别为(800.47±564.95)mL、(29.86±17.37)g/L、(0.14±0.06)L/L,前者均低于后者,差异有统计学意义(P<0.05)。但两组间在术中失血量、异体输血率及引流量方面差异无统计学意义(P>0.05)。腰硬联合麻醉组患者术后住院时间要略少于全身麻醉组(P=0.04),而术后1个月关节活动度及治疗费用等方面,两组之间差异无统计学意义(P>0.05)。两组间术后并发症发生率,差异无统计学意义(P>0.05)。结论对于接受初次单侧TKA的患者,腰硬联合麻醉在控制围术期总失血量方面更有优势,也有利于缩短术后的康复时间,但对于术后关节活动度和术后并发症方面,没有明显优势。

Objective To evaluate the effect of combined spinal epidural anesthesia and general anesthesia,on perioperative blood loss and postoperative complications in patients undergoing initial total knee arthroplasty(TKA).Methods The medical records of 3568 patients who underwent initial unilateral TKA at Luoyang Orthopedic Hospital in Henan Province from January 2015 to December 2019 were collected for retrospective analysis.Of these,966 patients were in the combined spinal epidural anesthesia group,with 210 males and 756 females.Their ages ranged from 45 to 85 years old,with a mean age of(66.69±7.70)years old.Additionally,2602 patients were in the general anesthesia group,including 597 males and 2005 females.Their ages also spanned from 46 to 85 years old,averaging(66.63±7.56)years old.We further compared the general baseline indicators,encompassing diagnosis,coexisting diseases,blood volume,preoperative hemoglobin levels,preoperative haematocrit values,surgical side,and operation time.The objective was to analyze the total perioperative blood loss,intraoperative blood loss,allogeneic transfusion rate,drainage volume,as well as changes in hemoglobin and haematocrit levels in both groups.Furthermore,we documented the occurrence of postoperative complications,such as deep vein thrombosis,pulmonary embolism,nausea and vomiting,and electrolyte imbalances.Lastly,we evaluated the duration of postoperative hospitalization,rehabilitation outcomes including knee mobility at one month postoperatively,and the cost of inpatient treatment in both anesthesia groups.Results The perioperative total blood loss,maximum change in haemoglobin,and maximum change in haematocrit were(743.67±546.36)mL,(27.94±17.85)g/L,and(0.14±0.05)L/L in the combined spinal epidural anesthesia group,and(800.47±564.95)mL,(29.86±17.37)g/L,and(0.14±0.06)L/L in the general anaesthesia group.The former values were lower than the latter,and the difference was statistically significant(P<0.05).However,there was no statistically significant difference in intraoperative blood loss,allogeneic transfusion rate,and drainage volume between the two groups(P>0.05).The postoperative hospital stay of patients in the combined spinal epidural anesthesia group was slightly shorter than that of the general anaesthesia group(P=0.04),while the differences between the two groups were not statistically significant in terms of joint mobility and treatment costs at 1 month after operation(P>0.05).The incidence of postoperative complications was also not statistically significant between the two groups(P>0.05).Conclusion In patients undergoing initial unilateral TKA,combined spinal epidural anesthesia was more advantageous in controlling total perioperative blood loss and in shortening the postoperative recovery time.However,there were no significant advantages in terms of postoperative joint mobility and postoperative complication rates.