Adams H A, Wolf C, Michaelis G, Hempelmann G
Abteilung für Anästhesiologie und operative Intensivmedizin, Justus-Liebig-Universität Giessen.
Anasth Intensivther Notfallmed. 1990 Aug;25(4):263-70.
During a period of one year, all patients above the age of 60 with surgical repair of fractured neck of femur were investigated in a prospectively randomized design. A follow-up study included a total number of 56 patients, 32 were allocated to halothane anaesthesia with intubation, 24 received spinal anaesthesia. In addition, 15 patients of the halothane group and 17 patients with spinal anaesthesia were investigated with regard to endocrine stress response. Total mortality was 12.5%, and different anaesthetic management had no influence on the postoperative course. During the operation, adrenaline and ADH increased in both groups. This increase was attenuated by spinal anaesthesia. Noradrenaline was markedly increased even before the operation, and concentrations increased in the halothane group in the course of the operation. There was a linear correlation to time between accident and the beginning of the operation. With regard to endocrine parameters, prompt surgical treatment is beneficial.
在一年的时间里，采用前瞻性随机设计对所有60岁以上接受股骨颈骨折手术修复的患者进行了调查。一项随访研究共纳入56例患者，32例分配至插管氟烷麻醉组，24例接受脊髓麻醉。此外，对氟烷组的15例患者和脊髓麻醉组的17例患者进行了内分泌应激反应调查。总死亡率为12.5%，不同的麻醉管理对术后病程无影响。手术期间，两组患者的肾上腺素和抗利尿激素均升高。脊髓麻醉可减轻这种升高。去甲肾上腺素甚至在手术前就显著升高，氟烷组在手术过程中其浓度升高。事故发生至手术开始的时间与去甲肾上腺素浓度呈线性相关。就内分泌参数而言，及时的手术治疗是有益的。
