Department of Anesthesiology, The University of Texas Medical School at Houston, Houston, TX 77030-1501, USA.
Minerva Anestesiol. 2011 Jul;77(7):715-22. Epub 2011 Feb 1.
The comprehensive management of proximal hip fractures in elderly patients requires dedicated and responsive teamwork. Elderly patients often present with several comorbidities and the immediate treatment of a fracture has to optimize both medical therapy and analgesic control in order to reduce surgical and anesthetic complications and to preserve as much cognitive functioning as possible. The elderly are uniquely exposed to complications related to bed rest, delirium and postoperative cognitive dysfunction (POCD), which appear to be independent factors of morbidity. Anesthetic management that includes good perioperative pain management can influence the patient's inflammatory response and possibly decrease the incidence of POCD. The best choice of surgical treatment depends on the type of fracture as well as the patient's age and medical condition. However, the type of anesthesia management, which includes neuraxial blocks, peripheral nerve blocks and/or general anesthesia, has to be tailored towards generated the best outcome. We present a review from a surgical and anesthetic perspective on the most common perioperative issues in proximal fracture repair.
老年患者的近端髋部骨折的综合管理需要专门的、有响应能力的团队合作。老年患者通常伴有多种合并症，骨折的即刻治疗必须优化药物治疗和镇痛控制，以减少手术和麻醉并发症，并尽可能保留认知功能。老年人特别容易出现与卧床休息、谵妄和术后认知功能障碍（POCD）相关的并发症，这些并发症似乎是发病率的独立因素。包括良好围手术期疼痛管理的麻醉管理可以影响患者的炎症反应，并可能降低 POCD 的发生率。最佳的手术治疗选择取决于骨折类型以及患者的年龄和身体状况。然而，麻醉管理的类型，包括椎管内阻滞、外周神经阻滞和/或全身麻醉，必须针对产生最佳结果进行调整。我们从手术和麻醉的角度对近端骨折修复中最常见的围手术期问题进行了综述。
