目的比较区域麻醉和全身麻醉对老年单侧下肢骨折术后康复的影响。方法回顾本院2017年5月至2018年4月间行单侧下肢骨折手术的老年患者116例,男35例,女81例,年龄65～98岁,ASAⅠ—Ⅳ级。根据麻醉方式分为区域麻醉组(RA组,n=50)和全身麻醉组...目的比较区域麻醉和全身麻醉对老年单侧下肢骨折术后康复的影响。方法回顾本院2017年5月至2018年4月间行单侧下肢骨折手术的老年患者116例,男35例,女81例,年龄65～98岁,ASAⅠ—Ⅳ级。根据麻醉方式分为区域麻醉组(RA组,n=50)和全身麻醉组(GA组,n=66),记录两组患者性别、年龄、ASA分级、骨折部位、术前1 d Barthel评分和分级等术前基线资料;术式、手术时间和失血量等手术相关资料,ICU停留时间、术毕至下床活动时间、术后住院时间、术后3 d Barthel评分和分级等术后康复相关资料,建立3个Logistic回归模型记录2种麻醉方式老年单侧下肢骨折术后Barthel的评分。结果 RA组年龄明显大于GA组(P<0.05)。两组性别、ASA分级、骨折部位、术式、手术时间和失血量、ICU停留时间、术毕至下床活动时间、术后住院时间,术前1 d Barthel评分和分级等差异均无统计学意义。术后3 d RA组Barthel评分明显高于GA组(P<0.05),Barthel分级为III或IV级的比例明显低于GA组(P<0.05)。采用二元Logistic回归进一步调整潜在混杂因素,分析麻醉方式与术后3 d Barthel分级的关联强度,建立3个回归模型以去除潜在混杂因素影响后,RA组患者出现术后3 d Barthel分级为Ⅲ级或Ⅳ级的危险明显低于GA组(P<0.05)。按照模型1调整年龄因素后OR=0.235, 95%CI 0.103～0.538,P=0.001;按照模型2调整年龄和性别因素后OR=0.207, 95%CI 0.087～0.490,P<0.001;按照模型3调整年龄、性别和ASA分级因素后OR=0.210, 95%CI 0.088～0.498,P<0.001。结论老年患者行单侧下肢骨折手术时,与全身麻醉比较,区域麻醉更有助于患者提高Barthel评分,有助于早期康复。展开更多
Objective Identification of the risk factors for extraordinary hidden blood loss(HBL) could clarify the underlying causes and provide more appropriate management. This study aims to identify the predictors of HBL in s...Objective Identification of the risk factors for extraordinary hidden blood loss(HBL) could clarify the underlying causes and provide more appropriate management. This study aims to identify the predictors of HBL in spinal surgery.Methods Medical records were retrospectively retrieved to collect the data of patients who undergoing posterior thoracic and lumbar fusion surgery or scoliosis surgery. Demographic information, perioperative visible blood loss volume, as well as laboratory results were recorded. The patients receiving fusion surgery or scoliosis surgery were further divided into the HBL positive subgroup and the HBL negative subgroup. Differences in the variables between the groups were then analyzed. Binary logistic regression analysis was performed to determine independent risk factors associated with HBL.Results For patients undergoing posterior spinal surgery, the independent risk factors associated with HBL were autologous transfusion(for fusion surgery P = 0.011, OR: 2.627, 95%CI: 1.574-2.782; for scoliosis surgery P < 0.001, OR: 2.268, 95%CI: 2.143-2.504) and allogeneic transfusion(for fusion surgery P < 0.001, OR: 6.487, 95%CI: 2.349-17.915; for scoliosis surgery P < 0.001, OR: 3.636, 95%CI: 2.389-5.231).Conclusion Intraoperative blood transfusion might be an early-warning indicator for perioperative HBL.展开更多
文摘目的比较区域麻醉和全身麻醉对老年单侧下肢骨折术后康复的影响。方法回顾本院2017年5月至2018年4月间行单侧下肢骨折手术的老年患者116例,男35例,女81例,年龄65～98岁,ASAⅠ—Ⅳ级。根据麻醉方式分为区域麻醉组(RA组,n=50)和全身麻醉组(GA组,n=66),记录两组患者性别、年龄、ASA分级、骨折部位、术前1 d Barthel评分和分级等术前基线资料;术式、手术时间和失血量等手术相关资料,ICU停留时间、术毕至下床活动时间、术后住院时间、术后3 d Barthel评分和分级等术后康复相关资料,建立3个Logistic回归模型记录2种麻醉方式老年单侧下肢骨折术后Barthel的评分。结果 RA组年龄明显大于GA组(P<0.05)。两组性别、ASA分级、骨折部位、术式、手术时间和失血量、ICU停留时间、术毕至下床活动时间、术后住院时间,术前1 d Barthel评分和分级等差异均无统计学意义。术后3 d RA组Barthel评分明显高于GA组(P<0.05),Barthel分级为III或IV级的比例明显低于GA组(P<0.05)。采用二元Logistic回归进一步调整潜在混杂因素,分析麻醉方式与术后3 d Barthel分级的关联强度,建立3个回归模型以去除潜在混杂因素影响后,RA组患者出现术后3 d Barthel分级为Ⅲ级或Ⅳ级的危险明显低于GA组(P<0.05)。按照模型1调整年龄因素后OR=0.235, 95%CI 0.103～0.538,P=0.001;按照模型2调整年龄和性别因素后OR=0.207, 95%CI 0.087～0.490,P<0.001;按照模型3调整年龄、性别和ASA分级因素后OR=0.210, 95%CI 0.088～0.498,P<0.001。结论老年患者行单侧下肢骨折手术时,与全身麻醉比较,区域麻醉更有助于患者提高Barthel评分,有助于早期康复。
文摘Objective Identification of the risk factors for extraordinary hidden blood loss(HBL) could clarify the underlying causes and provide more appropriate management. This study aims to identify the predictors of HBL in spinal surgery.Methods Medical records were retrospectively retrieved to collect the data of patients who undergoing posterior thoracic and lumbar fusion surgery or scoliosis surgery. Demographic information, perioperative visible blood loss volume, as well as laboratory results were recorded. The patients receiving fusion surgery or scoliosis surgery were further divided into the HBL positive subgroup and the HBL negative subgroup. Differences in the variables between the groups were then analyzed. Binary logistic regression analysis was performed to determine independent risk factors associated with HBL.Results For patients undergoing posterior spinal surgery, the independent risk factors associated with HBL were autologous transfusion(for fusion surgery P = 0.011, OR: 2.627, 95%CI: 1.574-2.782; for scoliosis surgery P < 0.001, OR: 2.268, 95%CI: 2.143-2.504) and allogeneic transfusion(for fusion surgery P < 0.001, OR: 6.487, 95%CI: 2.349-17.915; for scoliosis surgery P < 0.001, OR: 3.636, 95%CI: 2.389-5.231).Conclusion Intraoperative blood transfusion might be an early-warning indicator for perioperative HBL.
