全身麻醉在接受髖關節骨折復位手術的老老人是手術併發症的危險因子; General anesthesia is a risk factor of morbidity in very old hip fracture repair patients

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Title:	全身麻醉在接受髖關節骨折復位手術的老老人是手術併發症的危險因子;General anesthesia is a risk factor of morbidity in very old hip fracture repair patients
Authors:	施怡如;Yi-Ju Shih
Contributors:	中國醫藥大學：醫學研究所碩士班
Keywords:	髋;關節骨折;全身麻醉;hip fracture;general anesthesia
Date:	2007-07-16
Issue Date:	2009-08-13 14:50:40 (UTC+8)
Abstract:	實驗目的: 本回溯性實驗的目的是要比較在接受髖關節骨折復位手術的八十歲以上老人，接受全身麻醉和脊椎麻醉者其手術後死亡率及併發症比率是否不同。並探討其發生併發症的可能危險因子。實驗方法: 本實驗收集了2002至2006 年間在台中榮總接受髖關節骨折復位手術的八十歲以上老人共335人，其中全身麻醉168人脊椎麻醉167人，比較其死亡率及併發症比率，及術前術中的各項影響因子是否會影響併發症的發生,並分析常見併發症的可能原因。研究結果: 脊椎麻醉組病人平均年齡較老，而全身麻醉組病人較多高血壓及糖尿病病史。兩組死亡率並無差別〔全身麻醉 5人(3.0%)，脊椎麻醉 2 人(1.2%)〕，但併發症比率全身麻醉明顯較多〔全身麻醉 21人(12.6%) vs脊椎麻醉 9 人(5.4%)〕，且多為呼吸道相關併發症，最多的併發症為肺炎 9人(3.58%)。經邏輯迴歸分析發現，併發症發生的相關危險因子為全身麻醉及呼吸道病史( 風險值分別為2.39 與3.38)。全身麻醉及呼吸道病史也是呼吸道相關併發症的危險因子。因此全身麻醉較容易引發呼吸道併發症，而呼吸道併發症也是併發症中最常見的一種研究結論:接受髖關節骨折復位手術的八十歲以上老人，全身麻醉及呼吸道病史會增加手術風險。而脊椎麻醉可以減少手術出血量，縮短手術時間，1並減少呼吸道併發症，可能是較安全的麻醉方式。 Purpose: This study compared postoperative morbidity and mortality in elderly patients who received either general or spinal anesthesia for hip fracture repair. Methods: We retrospectively analyzed the hospital records of 335 elderly patients (> 80 years old) who received hip fracture repair in our hospital between 2002 and 2006. A total of 167 and 168 patients received general and spinal anesthesia, respectively. Morbidity, mortality, and intraoperative and preoperative variables were compared between groups. Results: There were no mortality differences between spinal and general anesthesia groups. However, surgery duration and blood loss during surgery were significantly greater in general anesthesia patients, which may have contributed to the greater overall morbidity in the general anesthesia group (n = 21 [12.6%] general vs n = 9 [5.4%] spinal, P = 0.02). Respiratory-system–related morbidity was also higher in the general anesthesia group (n = 11 [6.6%] general vs n = 3 [1.8%] spinal). Logistic regression analysis revealed two significant predictors of postoperative morbidity: anesthesia type (general, odds ratio 2.39) and pre-existing respiratory diseases (odds ratio 3.38). Conclusions: General anesthesia increased the occurrence of postoperative morbidity in elderly patients after hip fracture repair, and patients with preexisting respiratory diseases were especially vulnerable. Therefore, spinal anesthesia may be a better option in such individuals. Key words: hip fracture, general anesthesia, spinal anesthesia, elderly, morbidity, mortality.
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