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中华老年骨科与康复电子杂志 ›› 2025, Vol. 11 ›› Issue (01) : 39 -45. doi: 10.3877/cma.j.issn.2096-0263.2025.01.006

麻醉医学

麻醉方式选择对髋部骨折患者预后的影响
王晓伟1, 杨红梅1, 高杰1, 征华勇1, 刘智1, 孙天胜1,   
  1. 1. 100700 北京,中国人民解放军总医院第7医学中心骨科
  • 收稿日期:2023-10-26 出版日期:2025-02-05
  • 通信作者: 孙天胜
  • 基金资助:
    全军后勤科研重点项目(BLJ18J006)北京市科技新星计划专项(Z181100006218031)

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

Xiaowei Wang1, Hongmei Yang1, Jie Gao1, Huayong Zheng1, Zhi Liu1, Tiansheng Sun1,   

  1. 1. Department of Orthopaedics,7th Medical Center,General Hospital of the Chinese People's Liberation Army,BeiJing 100700,China
  • Received:2023-10-26 Published:2025-02-05
  • Corresponding author: Tiansheng Sun
引用本文:

王晓伟, 杨红梅, 高杰, 征华勇, 刘智, 孙天胜. 麻醉方式选择对髋部骨折患者预后的影响[J/OL]. 中华老年骨科与康复电子杂志, 2025, 11(01): 39-45.

Xiaowei Wang, Hongmei Yang, Jie Gao, Huayong Zheng, Zhi Liu, Tiansheng Sun. The influence of type of anesthesia selection on the prognosis of hip fractures[J/OL]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2025, 11(01): 39-45.

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1 177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 1 177 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 anesthe-sia is less prone to cerebrovascular complications and venous thrombosis after surgery.

表1 不同麻醉方式髋部骨折患者的人口学资料比较
表2 不同麻醉方式髋部骨折患者的术中资料比较
表3 调整后不同麻醉方式髋部骨折患者的术后死亡风险
表4 不同麻醉方式髋部骨折患者的术后并发症比较
表5 调整后不同麻醉方式髋部骨折患者的术后并发症比较
表6 不同麻醉方式髋部骨折患者的VAS评分比较(分,
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