在全部和膝盖关节整形术后的发病率和死亡率与脊柱相对于全身麻醉:回顾性分析
Samantha C Diulus1, Carlos Mucharraz2, Daniel R Schmitt1
1Department of Orthopaedic Surgery, Loyola University Medical Center, Maywood, Illinois.
The Journal of arthroplasty
|May 4, 2024
概括
一般麻醉 (GA) 可能会增加深静脉血栓塞和肺栓塞的风险在全关节整形术 (TJA) 患者中,特别是在关节置换后. 脊柱麻醉 (SA) 和GA在膝关节置换中看起来可以比较.
科学领域:
- 整形外科手术 整形外科手术
- 麻醉学 麻醉学
- 医学成果研究研究成果
背景情况:
- 对于全关节整形术 (TJA) 的最佳麻醉方法仍在争论中.
- 现有的文献显示,关于脊髓麻醉 (SA) 与全身麻醉 (GA) 在TJA结果中的优越性,存在相互矛盾的证据.
- 骨折研究缺乏关于SA与GA益处的明确共识.
研究的目的:
- 在接受初级TJA的患者中,研究和比较GA和SA之间的术后发病率和死亡率.
- 确定麻醉选择是否显著影响关节整形术 (THA) 和膝关节整形术 (TKA) 后的患者结果.
主要方法:
- 从2007年2月到2021年2月,对原发性THA和TKA患者的回顾性审查.
- 分析了四个患者队列:THA/GA,THA/SA,TKA/GA和TKA/SA.
- 包括90天再入院,365天死亡率和30天血栓栓塞事件在内的结果使用后勤回归进行了比较,控制了共变量.
主要成果:
- 在THA/GA (OR=3.1) 和TKA/GA (OR=1.9) 队列中,全身麻醉 (GA) 与30天深静脉血栓形成 (DVT) 的几率显著增加.
- THA/GA组显示30天肺栓塞 (PE) 的几率增加 (OR=3.9).
- 在THA/GA队列中观察到更高的365天死亡率 (OR=4.3);在TKA患者中没有发现显著差异.
结论:
- 脊柱麻醉 (SA) 和全身麻醉 (GA) 都是初级全膝关节整形术 (TKA) 的可行选择,风险概况相似.
- 全身麻醉 (GA) 可能与TJA深静脉血栓的增加率和肺栓塞有关,特别是在全关节整形术 (THA) 中.
- 在THA后,GA与增加1年死亡率之间的潜在关联需要谨慎解释.
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