Schäfer M, Elke R, Young J R, Gancs P, Kindler C H
Department of Anaesthesia, University Hospital Basel, basel, Swizerland.
J Bone Joint Surg Br. 2005 Aug;87(8):1134-9. doi: 10.1302/0301-620X.87B8.16207.
Using a computer-based quality assurance program, we analysed peri-operative data on 160 patients undergoing one-stage bilateral hip or knee arthroplasties under regional anaesthesia with routine anaesthetic monitoring and only using peripheral intravenous access for peri-operative safety. We monitored defined intra-operative adverse events such as hypotension, myocardial ischaemia, arrhythmias, hypovolaemia, hypertension and early post-operative complications. We also determined post-operative hip and knee function, and patient satisfaction with different aspects of the anaesthetic management. Those patients undergoing one-stage bilateral arthroplasties were matched according to a cross-stratification which used three variables (American Society of Anesthesiologists' physical status scoring system, age and joint replaced) to patients undergoing unilateral hip or knee arthroplasties. Serious intra-operative adverse events were, with the exception of intra-operative hypotension, very infrequent in patients undergoing bilateral (nine adverse events) as well as unilateral arthroplasties (five adverse events). Early post-operative complications were also infrequent in both groups. However, the risks of receiving a heterologous blood transfusion (odds ratio 2.5; 95% confidence interval (CI) 1.3 to 5.0, estimated by exact conditional logistic regression) or vasoactive drugs (odds ratio 3.9; 95% CI 2.0 to 7.8) were significantly greater for patients undergoing bilateral operations. Patient satisfaction with anaesthesia was high; all patients who underwent the one-stage bilateral operation would choose the same anaesthetic technique again.
我们使用基于计算机的质量保证程序，分析了160例接受一期双侧髋关节或膝关节置换术患者的围手术期数据。这些手术在区域麻醉下进行，采用常规麻醉监测，仅通过外周静脉通路确保围手术期安全。我们监测了特定的术中不良事件，如低血压、心肌缺血、心律失常、低血容量、高血压以及早期术后并发症。我们还测定了术后髋关节和膝关节功能，以及患者对麻醉管理不同方面的满意度。接受一期双侧置换术的患者根据交叉分层法进行匹配，该分层法使用三个变量（美国麻醉医师协会身体状况评分系统、年龄和置换关节）与接受单侧髋关节或膝关节置换术的患者进行匹配。除术中低血压外，双侧置换术患者（9例不良事件）和单侧置换术患者（5例不良事件）术中严重不良事件均很少见。两组早期术后并发症也很少见。然而，接受双侧手术的患者接受异体输血的风险（比值比2.5；95%置信区间（CI）1.3至5.0，通过精确条件逻辑回归估计）或使用血管活性药物的风险（比值比3.9；95%CI 2.0至7.8）显著更高。患者对麻醉的满意度很高；所有接受一期双侧手术的患者都愿意再次选择相同的麻醉技术。
