Karaca Saffet, Ayhan Egemen, Kesmezacar Hayrettin, Uysal Omer
Department of Anesthesiology and Reanimation, Cerrahpasa Medical Faculty, Istanbul University, 34098 Istanbul, Turkey.
Anesthesiol Res Pract. 2012;2012:708754. doi: 10.1155/2012/708754. Epub 2012 Jan 12.
We hypothesized that combined peripheral nerve block (CPNB) technique might reduce mortality in hip fracture patients with the advantage of preserved cardiovascular stability. We retrospectively analyzed 257 hip fracture patients for mortality rates and affecting factors according to general anesthesia (GA), neuraxial block (NB), and CPNB techniques. Patients' gender, age at admission, trauma date, ASA status, delay in surgery, followup period, and Barthel Activities of Daily Living Index were determined. There were no differences between three anesthesia groups regarding to sex, followup, delay in surgery, and Barthel score. NB patients was significantly younger and CPNB patients' ASA status were significantly worse than other groups. Mortality was lower for regional group (NB + CPNB) than GA group. Mortality was increased with age, delay in surgery, and ASA and decreased with CPNB choice; however, it was not correlated with NB choice. Since the patients' age and ASA status cannot be changed, they must be operated immediately. We recommend CPNB technique in high-risk patients to operate them earlier.
我们推测，联合外周神经阻滞（CPNB）技术可能会降低髋部骨折患者的死亡率，其优势在于能维持心血管稳定性。我们根据全身麻醉（GA）、神经轴索阻滞（NB）和CPNB技术，对257例髋部骨折患者的死亡率及影响因素进行了回顾性分析。确定了患者的性别、入院年龄、受伤日期、美国麻醉医师协会（ASA）分级、手术延迟时间、随访期以及巴氏日常生活活动指数。在性别、随访、手术延迟和巴氏评分方面，三个麻醉组之间没有差异。NB组患者明显更年轻，CPNB组患者的ASA分级明显比其他组差。区域阻滞组（NB + CPNB）的死亡率低于GA组。死亡率随年龄、手术延迟和ASA分级增加而升高，随CPNB的选择而降低；然而，它与NB的选择无关。由于患者的年龄和ASA分级无法改变，必须立即进行手术。我们建议在高危患者中采用CPNB技术，以便更早地进行手术。
