NEJM:老年人髋关节手术该选腰麻还是全麻?

2021-11-25 MedSci原创 MedSci原创

老年人髋部骨折手术的腰麻在60天的存活和下地恢复方面并不优于全身麻醉。两种麻醉方式术后谵妄发生率相似。

与全身麻醉相比,腰麻对接受髋部骨折手术的老年人行走能力的影响尚未得到充分研究。

近日,顶级医学期刊NEJM上发表了一篇研究文章,研究人员进行了一项务实的随机优效性试验,以在46家美国和加拿大医院接受髋部骨折手术的50岁或以上的先前非卧床患者比较了腰麻与全身麻醉的效果。患者以1:1的比例随机分配接受腰麻或全身麻醉。该研究的主要结局是随机分组后60天死亡或无法独立行走超过3m或使用助行器或手杖行走的复合结局。该研究的次要结局包括60天内死亡、谵妄、出院时间和60天内下地活动。

该研究共招募了1600名患者;795人被分配接受腰麻,805人被分配接受全身麻醉。受试者平均年龄为78岁,67.0%的患者为女性。分配到腰麻的666名患者(83.8%)和分配到全身麻醉的769名患者(95.5%)接受了指定的麻醉。在可获得数据的改良意向治疗人群中,在腰麻组712例患者中有132例(18.5%)患者和全身麻醉组733例患者中有132例(18.0%)患者发生主要复合结局(相对风险为1.03;95%置信区间[CI]为0.84至1.27;P=0.83)。

腰麻组684名患者中有104名(15.2%)患者和全麻组702名患者中有101名(14.4%)患者分别报告了60天无法独立行走(相对风险为1.06;95%CI为0.82至1.36),并且分别在768例中的30例(3.9%)和784例中的32例(4.1%)患者在60天内发生死亡(相对风险为0.97;95%CI为0.59至1.57)。腰麻组633名患者中的130名(20.5%)和全身麻醉组629名患者中的124名(19.7%)患者发生谵妄(相对风险为1.04;95%CI为0.84至1.30)。

由此可见,老年人髋部骨折手术的腰麻在60天的存活和下地恢复方面并不优于全身麻醉。两种麻醉方式术后谵妄发生率相似。

原始出处:
 
Mark D. Neuman,et al.Spinal Anesthesia or General Anesthesia for Hip Surgery in Older Adults.NEJM.2021.https://www.nejm.org/doi/full/10.1056/NEJMoa2113514

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  1. [GetPortalCommentsPageByObjectIdResponse(id=1187894, encodeId=75b6118e8944d, content=有指导意义, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=78f13025060, createdName=1509076156, createdTime=Tue Jan 25 05:47:57 CST 2022, time=2022-01-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1183405, encodeId=b1ed1183405e8, content=可以参考, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5a7a2999519, createdName=hmily19870412, createdTime=Wed Jan 12 00:40:32 CST 2022, time=2022-01-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1078658, encodeId=7c7910e865862, content=有意思, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150625/IMG558B8C995D7262168.jpg, createdBy=36ad1623080, createdName=cyzj007, createdTime=Fri Dec 10 08:36:51 CST 2021, time=2021-12-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1074406, encodeId=2eda10e44062d, content=<a href='/topic/show?id=bf0f1030431a' target=_blank style='color:#2F92EE;'>#麻醉#</a><a href='/topic/show?id=af1310206642' target=_blank style='color:#2F92EE;'>#髋关节置换术#</a>,这个研究十分有价值,主要关注麻醉后的POCT是否增加?, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=1, topicName=null, topicId=null, topicList=[TopicDto(id=103043, encryptionId=bf0f1030431a, topicName=麻醉), TopicDto(id=102066, encryptionId=af1310206642, topicName=髋关节置换术)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211210/ede9c51184aa4f54ae6c1164cfb8eeac/967dbf3eff2943c7bf3ccfec3a776ab0.JPG, createdBy=a33789389, createdName=病毒猎手, createdTime=Sat Nov 27 07:41:20 CST 2021, time=2021-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1476603, encodeId=703a14e660349, content=<a href='/topic/show?id=6ff229e7126' target=_blank style='color:#2F92EE;'>#全麻#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=29771, encryptionId=6ff229e7126, topicName=全麻)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=56097291776, createdName=pps20021, createdTime=Sat Nov 27 08:55:08 CST 2021, time=2021-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1546152, encodeId=d47b1546152b1, content=<a href='/topic/show?id=44b18551213' target=_blank style='color:#2F92EE;'>#腰麻#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85512, encryptionId=44b18551213, topicName=腰麻)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3d2713885750, createdName=ms1774076774505970, createdTime=Sat Nov 27 08:55:08 CST 2021, time=2021-11-27, status=1, ipAttribution=)]
    2022-01-25 1509076156

    有指导意义

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1187894, encodeId=75b6118e8944d, content=有指导意义, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=78f13025060, createdName=1509076156, createdTime=Tue Jan 25 05:47:57 CST 2022, time=2022-01-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1183405, encodeId=b1ed1183405e8, content=可以参考, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5a7a2999519, createdName=hmily19870412, createdTime=Wed Jan 12 00:40:32 CST 2022, time=2022-01-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1078658, encodeId=7c7910e865862, content=有意思, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150625/IMG558B8C995D7262168.jpg, createdBy=36ad1623080, createdName=cyzj007, createdTime=Fri Dec 10 08:36:51 CST 2021, time=2021-12-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1074406, encodeId=2eda10e44062d, content=<a href='/topic/show?id=bf0f1030431a' target=_blank style='color:#2F92EE;'>#麻醉#</a><a href='/topic/show?id=af1310206642' target=_blank style='color:#2F92EE;'>#髋关节置换术#</a>,这个研究十分有价值,主要关注麻醉后的POCT是否增加?, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=1, topicName=null, topicId=null, topicList=[TopicDto(id=103043, encryptionId=bf0f1030431a, topicName=麻醉), TopicDto(id=102066, encryptionId=af1310206642, topicName=髋关节置换术)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211210/ede9c51184aa4f54ae6c1164cfb8eeac/967dbf3eff2943c7bf3ccfec3a776ab0.JPG, createdBy=a33789389, createdName=病毒猎手, createdTime=Sat Nov 27 07:41:20 CST 2021, time=2021-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1476603, encodeId=703a14e660349, content=<a href='/topic/show?id=6ff229e7126' target=_blank style='color:#2F92EE;'>#全麻#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=29771, encryptionId=6ff229e7126, topicName=全麻)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=56097291776, createdName=pps20021, createdTime=Sat Nov 27 08:55:08 CST 2021, time=2021-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1546152, encodeId=d47b1546152b1, content=<a href='/topic/show?id=44b18551213' target=_blank style='color:#2F92EE;'>#腰麻#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85512, encryptionId=44b18551213, topicName=腰麻)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3d2713885750, createdName=ms1774076774505970, createdTime=Sat Nov 27 08:55:08 CST 2021, time=2021-11-27, status=1, ipAttribution=)]
    2022-01-12 hmily19870412

    可以参考

    0

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    2021-12-10 cyzj007

    有意思

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1187894, encodeId=75b6118e8944d, content=有指导意义, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=78f13025060, createdName=1509076156, createdTime=Tue Jan 25 05:47:57 CST 2022, time=2022-01-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1183405, encodeId=b1ed1183405e8, content=可以参考, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5a7a2999519, createdName=hmily19870412, createdTime=Wed Jan 12 00:40:32 CST 2022, time=2022-01-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1078658, encodeId=7c7910e865862, content=有意思, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150625/IMG558B8C995D7262168.jpg, createdBy=36ad1623080, createdName=cyzj007, createdTime=Fri Dec 10 08:36:51 CST 2021, time=2021-12-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1074406, encodeId=2eda10e44062d, content=<a href='/topic/show?id=bf0f1030431a' target=_blank style='color:#2F92EE;'>#麻醉#</a><a href='/topic/show?id=af1310206642' target=_blank style='color:#2F92EE;'>#髋关节置换术#</a>,这个研究十分有价值,主要关注麻醉后的POCT是否增加?, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=1, topicName=null, topicId=null, topicList=[TopicDto(id=103043, encryptionId=bf0f1030431a, topicName=麻醉), TopicDto(id=102066, encryptionId=af1310206642, topicName=髋关节置换术)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211210/ede9c51184aa4f54ae6c1164cfb8eeac/967dbf3eff2943c7bf3ccfec3a776ab0.JPG, createdBy=a33789389, createdName=病毒猎手, createdTime=Sat Nov 27 07:41:20 CST 2021, time=2021-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1476603, encodeId=703a14e660349, content=<a href='/topic/show?id=6ff229e7126' target=_blank style='color:#2F92EE;'>#全麻#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=29771, encryptionId=6ff229e7126, topicName=全麻)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=56097291776, createdName=pps20021, createdTime=Sat Nov 27 08:55:08 CST 2021, time=2021-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1546152, encodeId=d47b1546152b1, content=<a href='/topic/show?id=44b18551213' target=_blank style='color:#2F92EE;'>#腰麻#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85512, encryptionId=44b18551213, topicName=腰麻)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3d2713885750, createdName=ms1774076774505970, createdTime=Sat Nov 27 08:55:08 CST 2021, time=2021-11-27, status=1, ipAttribution=)]
    2021-11-27 病毒猎手

    #麻醉##髋关节置换术#,这个研究十分有价值,主要关注麻醉后的POCT是否增加?

    1

    展开1条回复
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    2021-11-27 pps20021
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