文章摘要
区域麻醉和全身麻醉用于老年下肢骨折患者术后康复的比较
Comparison of regional anesthesia and general anesthesia for postoperative rehabilitation in elderly patients with lower extremity fractures
  
DOI：10.12089/jca.2019.03.002
中文关键词: 老年患者  下肢骨折手术  Barthel评分  区域麻醉  全身麻醉
英文关键词: Elderly patients  Lower extremity fractures surgery  Barthel score  Regional anesthesia  General anesthesia
基金项目:
作者单位E-mail
白冰 100730,中国医学科学院,北京协和医学院,北京协和医院麻醉科  
张越伦 北京协和医院科研处中心实验室  
唐帅 100730,中国医学科学院,北京协和医学院,北京协和医院麻醉科 tangshuaipumch@163.com 
阮侠 100730,中国医学科学院,北京协和医学院,北京协和医院麻醉科  
申乐 100730,中国医学科学院,北京协和医学院,北京协和医院麻醉科  
田园 北京协和医学院临床医学八年制  
陈槺 北京协和医学院临床医学八年制  
金欣星 北京协和医学院临床医学八年制  
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中文摘要:
      
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，ASA Ⅰ—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。
英文摘要:
      
Objective To compare the effects of regional anesthesia and general anesthesia on postoperative rehabilitation in the elderly patients with unilateral lower extremity fractures.
Methods To review the perioperative data of 116 elderly patients undergoing unilateral lower extremity fracture surgery between May 2017 and April 2018 in our hospital, there were 35 males and 81 females, aged 65-98 years, with ASA physical status Ⅰ - Ⅳ. According to the method of anesthesia, they were divided into regional anesthesia group (group RA, n = 50) and general anesthesia group (group GA, n = 66) . We compared the preoperative baseline data between group RA and group GA including sex, age, fracture site, ASA classification, and preoperative 1d Barthel score and grading; surgery-related data including surgical methods, duration of surgery and blood loss; and postoperative rehabilitation related data including ICU length of stay, duration from the end of surgery to ambulation, postoperative hospitalization time, postoperative 3 d Barthel score and grade. And we used 3 Logistic regression models to compare the effects of two kinds of anesthesia on postoperative Barthel score in the elderly patients with unilateral lower extremity fractures.
Results The age of group RA was significantly higher than that of group GA (P < 0.05). There were no significant differences in gender, ASA classification, fracture site, surgical procedure, length of surgery, and blood loss, the ICU hospitalization time, duration from the end of surgery to ambulation, the postoperative hospital stay and preoperative 1d Barthel score and grade. The postoperative 3 d Barthel score in group RA was significantly higher than that in group GA (P < 0.05). The proportion of III or IV in group RA was lower than that in group GA (P < 0.05). Binary Logistic regression was used to further adjust the potential confounding factors, and the correlation intensity between anesthesia and postoperative 3d Barthel grade was analyzed. Three regression models were established to remove the potential confounding factors. The risk of being postoperative 3d grade III or IV was significantly lower in RA group than that of the GA group (P < 0.05). After adjusting the age factor according to model 1, OR = 0.235, 95% CI 0.103 - 0.538, P = 0.001; after adjusting age and gender factors according to model 2, OR = 0.207, 95% CI 0.087 - 0.490, P<0.001; and after adjusting age, gender, and ASA classification factors according to model 3, OR = 0.210, 95% CI 0.088 - 0.498, P<0.001.
Conclusion In elderly patients undergoing unilateral hip surgery, regional anesthesia may be more helpful for improving Barthel score and early rehabilitation than general anesthesia.
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