比较全身麻醉加气管插管、联合脊-硬联合麻醉、全身麻醉加喉罩气道和神经阻滞在老年患者股骨转子间骨折手术中的应用：一项回顾性队列研究。
Comparison of general anesthesia with endotracheal intubation, combined spinal-epidural anesthesia, and general anesthesia with laryngeal mask airway and nerve block for intertrochanteric fracture surgeries in elderly patients: a retrospective cohort study.
机构信息
Department of Orthopedics, Chengdu Aerospace Hospital, Chengdu, 610100, China.
Department of Anesthesia, Chengdu Aerospace Hospital, Chengdu, 610100, China.
出版信息
BMC Anesthesiol. 2019 Dec 17;19(1):230. doi: 10.1186/s12871-019-0908-2.
BACKGROUND
There is no consensus on the optimal anesthesia method for intertrochanteric fracture surgeries in elderly patients. Our study aimed to compare the hemodynamics and perioperative outcomes of general anesthesia with endotracheal intubation, combined spinal-epidural anesthesia, and general anesthesia with laryngeal mask airway (LMA) and nerve block for intertrochanteric fracture surgeries in elderly patients.
METHODS
This is a retrospective study of 75 patients aged > 60 years scheduled for intertrochanteric fracture surgeries with general anesthesia with intubation (n = 25), combined spinal-epidural anesthesia (n = 25), and general anesthesia with LMA and nerve block (n = 25). The intraoperative hemodynamics were recorded, and the maximum variation rate was calculated. Postoperative analgesic effect was evaluated using the visual analog scale (VAS). Postoperative cognitive status was assessed using the Mini-Mental State Exam (MMSE).
RESULTS
The maximum variation rate of intraoperative heart rate, systolic blood pressure, diastolic blood pressure differed significantly between the three groups (general anesthesia with intubation > combined spinal-epidural anesthesia > general anesthesia with LMA and nerve block). The VAS scores postoperative 2 h, 4 h, 6 h, and 8 h also differed significantly between the three groups (general anesthesia with intubation > combined spinal-epidural anesthesia > general anesthesia with LMA and nerve block). The VAS scores postoperative 24 h were significantly lower in the general anesthesia with LMA/nerve block group than the general anesthesia with intubation group and the combined spinal-epidural anesthesia group. The MMSE scores postoperative 15 min and 45 min differed significantly between the three groups (general anesthesia with intubation < combined spinal-epidural anesthesia < general anesthesia with LMA and nerve block). The MMSE scores postoperative 120 min in the general anesthesia with intubation group were the lowest among the three groups. There was no significant difference in the incidence of respiratory infection postoperative 24 h, 48 h, and 72 h between the three groups.
CONCLUSION
Compared to general anesthesia with intubation and combined spinal-epidural anesthesia, general anesthesia with LMA and nerve block had better postoperative analgesic effect and less disturbances on intraoperative hemodynamics and postoperative cognition for elderly patients undergoing intertrochanteric fracture surgeries.
背景
对于老年患者的股骨转子间骨折手术，目前尚无关于最佳麻醉方法的共识。我们的研究旨在比较全身麻醉气管插管、腰硬联合麻醉和全身麻醉喉罩气道（LMA）加神经阻滞在老年患者股骨转子间骨折手术中的血流动力学和围手术期结果。
方法
这是一项回顾性研究，纳入了 75 名年龄大于 60 岁的拟行股骨转子间骨折手术的患者，分为全身麻醉气管插管组（n=25）、腰硬联合麻醉组（n=25）和全身麻醉喉罩气道加神经阻滞组（n=25）。记录术中血流动力学，计算最大变化率。术后采用视觉模拟评分（VAS）评估镇痛效果。采用简易精神状态检查（MMSE）评估术后认知状态。
结果
三组患者术中心率、收缩压、舒张压的最大变化率差异均有统计学意义（全身麻醉气管插管组＞腰硬联合麻醉组＞全身麻醉喉罩气道加神经阻滞组）。术后 2h、4h、6h 和 8h 的 VAS 评分三组间差异也有统计学意义（全身麻醉气管插管组＞腰硬联合麻醉组＞全身麻醉喉罩气道加神经阻滞组）。术后 24h 时，全身麻醉喉罩气道/神经阻滞组的 VAS 评分明显低于全身麻醉气管插管组和腰硬联合麻醉组。术后 15min 和 45min 时，三组患者的 MMSE 评分差异有统计学意义（全身麻醉气管插管组＜腰硬联合麻醉组＜全身麻醉喉罩气道加神经阻滞组）。全身麻醉气管插管组术后 120min 的 MMSE 评分最低。三组患者术后 24h、48h 和 72h 的呼吸道感染发生率差异均无统计学意义。
结论
与全身麻醉气管插管和腰硬联合麻醉相比，全身麻醉喉罩气道加神经阻滞对老年股骨转子间骨折手术患者具有更好的术后镇痛效果，对术中血流动力学和术后认知功能的干扰更小。
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