我们应该在创伤性肋骨骨折患者中使用区域麻醉吗? 一个基于TQIP的研究
Marina Levochkina1, Carter Colwell2, Taneen Maghsoudi2
1Virginia Tech Carilion School of Medicine, Roanoke, Virginia.
The Journal of surgical research
|August 8, 2025
概括
对于肋骨骨折的区域麻醉没有影响死亡率. 然而,它与更长的住院时间和重症监护室 (ICU) 的入院增加有关,包括非计划的输管和ICU转移.
科学领域:
- 创伤外科 手术 创伤外科
- 麻醉学 麻醉学
- 关键护理医学 关键护理医学
背景情况:
- 肋骨骨折在创伤中很常见,导致肺炎和死亡等严重并发症.
- 多模式止痛,带或不带区域麻醉,是肋骨骨折疼痛管理的标准护理.
- 之前对区域麻醉疗法的有效性进行的单一机构研究产生了不同的结果.
研究的目的:
- 评估区域麻醉与孤立肋骨骨折的住院死亡率之间的关联.
- 评估二次结果,包括医院并发症和资源利用率 (呼吸机,ICU和住院时间).
- 利用国家创伤登记数据进行大规模分析.
主要方法:
- 使用了2021创伤质量改善计划 (TQIP) 国家注册表.
- 鉴定了患有孤立胸部创伤的患者,并根据接受区域麻醉 (表皮层或外围神经阻塞) 或没有区域麻醉进行分类.
- 雇员倾向匹配,以比较两个群体之间的结果.
主要成果:
- 在倾向匹配后,在每个组中分析了1295名患者 (区域麻醉与没有区域麻醉).
- 两组之间在住院死亡率上没有显著差异.
- 区域麻醉与增加住院时间,ICU入院,计划外的输管术和计划外的ICU升级有关.
结论:
- 基于TQIP数据的肋骨骨折管理区域麻醉没有显示死亡率有所降低.
- 区域麻醉的使用与资源利用率的增加相关,包括更长的住院时间和更高的ICU入院和干预率.
- 建议进行进一步的研究,以确定可能受益于区域麻醉技术的特定患者子组.
相关概念视频
Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia
564
Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
One of the advantages of...
One of the advantages of...
564
Local Anesthetics: Clinical Application as Spinal Anesthesia
778
Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
778
Local Anesthetics: Clinical Application as Epidural Anesthesia
498
Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
498
Flail Chest-II
235
Managing flail chest, a condition characterized by a segment of the chest wall moving independently from the rest of the thoracic cage, requires a comprehensive approach. It includes a thorough assessment of the patient's condition, a diagnostic evaluation to determine the extent of the injury, and the implementation of appropriate medical interventions tailored to the individual's needs.
Assessment:
1. Clinical Evaluation:
History:
Assessment:
1. Clinical Evaluation:
History:
235


