文章摘要
郑红波,梅伟,李勇,等.不同麻醉方式对老年全膝关节置换术早期预后的影响:一项单中心回顾性研究.骨科,2024,15(2): 109-114.
不同麻醉方式对老年全膝关节置换术早期预后的影响:一项单中心回顾性研究
Effects of Different Anesthetic Techniques on the Early Prognosis of Elderly Patients Undergoing Total Knee Arthroplasty: A Single-Center Retrospective Study
投稿时间:2023-12-30  
DOI:10.3969/j.issn.1674-8573.2024.02.003
中文关键词: 全膝关节置换  全身麻醉  腰麻  外周神经阻滞  早期预后
英文关键词: Total knee arthroplasty  General anesthesia  Spinal anesthesia  Peripheral nerve block  Early prognosis
基金项目:湖北省自然科学基金(2023AFB912)
作者单位E-mail
郑红波 华中科技大学同济医学院附属同济医院麻醉学与疼痛医学科、老年麻醉与围术期脑健康湖北省重点实验室、武汉市老年麻醉临床医学研究中心武汉 430030  
梅伟 华中科技大学同济医学院附属同济医院麻醉学与疼痛医学科、老年麻醉与围术期脑健康湖北省重点实验室、武汉市老年麻醉临床医学研究中心武汉 430030  
李勇 华中科技大学同济医学院附属同济医院骨科武汉 430030  
程鹏 华中科技大学同济医学院附属同济医院骨科武汉 430030  
花璐 华中科技大学同济医学院附属同济医院麻醉学与疼痛医学科、老年麻醉与围术期脑健康湖北省重点实验室、武汉市老年麻醉临床医学研究中心武汉 430030  
刘天柱 华中科技大学同济医学院附属同济医院麻醉学与疼痛医学科、老年麻醉与围术期脑健康湖北省重点实验室、武汉市老年麻醉临床医学研究中心武汉 430030 liutzh@126.com 
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中文摘要:
      目的 探讨不同麻醉方式对老年全膝关节置换术后早期预后的影响。方法 回顾性分析2018年10月至2021年9月在我院骨科行单侧全膝关节置换术病人的临床资料,根据麻醉方式分为全身麻醉组(GA组)、复合麻醉组(CA组)、外周神经阻滞组(PNB组)和腰麻组(SA组),与GA组和CA组比较,PNB组和SA组病人美国麻醉医师协会(ASA)分级,合并症比率更高,差异有统计学意义(P<0.05)。记录病人的一般资料、手术时间、麻醉时间、术后恢复室(PACU)观察时间和术后住院天数;记录低血压、血管活性药物泵注、术后24 h补救镇痛、舒芬太尼用量、术后炎性指标和48 h内并发症的发生率。结果 与GA组、CA组比较,PNB组和SA组病人低血压、低氧血症、血管活性药物泵注、急性心肌损伤、术后谵妄、术后恶心呕吐(PONV)、补救镇痛、入住ICU的发生率更低,舒芬太尼用量、炎性指标水平更低,术后PACU观察时间和住院时间缩短,差异均有统计学意义(P<0.05)。与GA组比较,CA组术中舒芬太尼用量、术中低血压、血管活性药物泵注和补救镇痛率显著降低,差异有统计学意义(P<0.05)。结论 与全身麻醉和复合麻醉相比,外周神经阻滞和腰麻是老年病人全膝关节置换术推荐的麻醉方式,可以改善早期预后。
英文摘要:
      Objective To explore the effects of different anesthesia techniques on the early prognosis of elderly patients undergoing total knee arthroplasty. Methods The data of patients who underwent elective unilateral total knee arthroplasty in the Department of Orthopedics of our hospital from October 2018 to September 2021 were analyzed. The patients were categorized into four groups based on the anesthetic methods: general anesthesia group (GA group), compound anesthesia group (CA group), peripheral nerve block group (PNB group), and spinal anesthesia group (SA group). The patients in the PNB and SA groups had a higher incidence of comorbidities and ASA classification than in the GA and CA groups. Patients' general information, operation time, anesthesia time, PACU observation time, and postoperative hospitalization days were recorded. The incidence of hypotension, vasoactive drug administration, postoperative remedial analgesia within 24 h, sufentanil dosage, postoperative inflammatory parameters, and the incidence of complications within 48 h were also recorded. Results The patients in the PNB group and SA group had a lower incidence of hypotension, lower rates of hypoxemia, less use of vasoactive agents, and lower incidence of acute myocardial injury, postoperative delirium, postoperative nausea and vomiting (PONV), lower rate of postoperative remedial analgesia, and lower rate of ICU admission (P<0.05). PNB group and SA group also had a lower sufentanil dosage, lower leukocytes and C-reactive protein level (P<0.05). Shorter postoperative PACU observation time and postoperative hospitalization time, with statistically significant differences were observed in two groups (P<0.05). The sufentamil dosage, incidence of intraoperative hypotension, vasoactive agents usage and rate of postoperative remedial analgesia were significantly reduced as compared with GA group (P<0.05). Conclusion Compared with general and combined anesthesia, peripheral nerve block and spinal anesthesia are recommended as anesthetic techniques for total knee arthroplasty in elderly patients to improve early prognosis.
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