Gulur Padma, Nishimori Mina, Ballantyne Jane C
Massachusetts General Hospital Pain Center, Harvard Medical School, Massachusetts General Hospital Pain Center, 15 Parkman Street, WACC 333, Boston, MA 02114, USA.
Best Pract Res Clin Anaesthesiol. 2006 Jun;20(2):249-63. doi: 10.1016/j.bpa.2005.10.002.
The regional versus general anaesthesia debate is an age-old debate that has brought about few clear answers. Most concur that multiple factors including the patient, the surgery, the method of regional and general anaesthesia, and the quality of perioperative care, all influence surgical outcome. In this age of evidence-based medicine, the heterogenous data available need to be reconciled with the advances in perioperative care and the significant decline in complications associated with the surgical process as a whole. This review considers general issues such as the type of available evidence, and its limitations, particularly with regard to the relatively broad question of neuraxial versus general anaesthesia. It then assesses current evidence on regional versus general anaesthesia for specific scenarios such as hip fracture surgery, carotid endarterectomy, Caesarean section, ambulatory orthopaedic surgery, and postoperative cognitive dysfunction in elderly patients after non-cardiac surgery.
区域麻醉与全身麻醉之争由来已久，却鲜有明确答案。多数人认同，包括患者、手术、区域麻醉和全身麻醉方法以及围手术期护理质量在内的多种因素，都会影响手术结果。在这个循证医学时代，现有的异质性数据需要与围手术期护理的进展以及整个手术过程相关并发症的显著减少相协调。本综述考虑了一些一般性问题，如现有证据的类型及其局限性，特别是关于神经轴索麻醉与全身麻醉这一相对宽泛问题的局限性。然后，针对特定情况，如髋部骨折手术、颈动脉内膜切除术、剖宫产、门诊骨科手术以及老年患者非心脏手术后的术后认知功能障碍，评估区域麻醉与全身麻醉的当前证据。
