睡眠呼吸暂停与各种麻醉下的人工关节置换术：一项围手术期结局的基于人群研究。
Sleep apnea and total joint arthroplasty under various types of anesthesia: a population-based study of perioperative outcomes.
机构信息
Department of Anesthesiology, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY 10021, USA.
出版信息
Reg Anesth Pain Med. 2013 Jul-Aug;38(4):274-81. doi: 10.1097/AAP.0b013e31828d0173.
BACKGROUND AND OBJECTIVES
The presence of sleep apnea (SA) among surgical patients has been associated with significantly increased risk of perioperative complications. Although regional anesthesia has been suggested as a means to reduce complication rates among SA patients undergoing surgery, no data are available to support this association. We studied the association of the type of anesthesia and perioperative outcomes in patients with SA undergoing joint arthroplasty.
METHODS
Drawing on a large administrative database (Premier Inc), we analyzed data from approximately 400 hospitals in the United States. Patients with a diagnosis of SA who underwent primary hip or knee arthroplasty between 2006 and 2010 were identified. Perioperative outcomes were compared between patients receiving general, neuraxial, or combined neuraxial-general anesthesia.
RESULTS
We identified 40,316 entries for unique patients with a diagnosis for SA undergoing primary hip or knee arthroplasty. Of those, 30,024 (74%) had anesthesia-type information available. Approximately 11% of cases were performed under neuraxial, 15% under combined neuraxial and general, and 74% under general anesthesia. Patients undergoing their procedure under neuraxial anesthesia had significantly lower rates of major complications than did patients who received combined neuraxial and general or general anesthesia (16.0%, 17.2%, and 18.1%, respectively; P = 0.0177). Adjusted risk of major complications for those undergoing surgery under neuraxial or combined neuraxial-general anesthesia compared with general anesthesia was also lower (odds ratio, 0.83 [95% confidence interval, 0.74-0.93; P = 0.001] vs odds ratio, 0.90 [95% confidence interval, 0.82-0.99; P = 0.03]).
CONCLUSIONS
Barring contraindications, neuraxial anesthesia may convey benefits in the perioperative outcome of SA patients undergoing joint arthroplasty. Further research is needed to enhance an understanding of the mechanisms by which neuraxial anesthesia may exert comparatively beneficial effects.
背景与目的
手术患者中存在睡眠呼吸暂停（SA）与围手术期并发症风险显著增加相关。尽管区域麻醉已被认为是降低 SA 患者手术并发症发生率的一种手段，但目前尚无数据支持这种关联。我们研究了 SA 患者行关节置换术时麻醉类型与围手术期结局的关系。
方法
利用大型行政数据库（Premier Inc），我们分析了美国约 400 家医院的数据。确定了 2006 年至 2010 年间诊断为 SA 并接受初次髋关节或膝关节置换术的患者。比较了接受全身麻醉、神经轴麻醉或联合神经轴-全身麻醉的患者的围手术期结局。
结果
我们确定了 40316 个独特的 SA 患者行初次髋关节或膝关节置换术的记录。其中，30024 例（74%）有麻醉类型信息。大约 11%的病例采用神经轴麻醉，15%采用联合神经轴和全身麻醉，74%采用全身麻醉。接受神经轴麻醉的患者主要并发症发生率明显低于接受联合神经轴-全身麻醉或全身麻醉的患者（分别为 16.0%、17.2%和 18.1%；P = 0.0177）。与全身麻醉相比，接受神经轴或联合神经轴-全身麻醉的患者发生主要并发症的风险也较低（比值比，0.83[95%置信区间，0.74-0.93；P = 0.001]，比值比，0.90[95%置信区间，0.82-0.99；P = 0.03]）。
结论
在没有禁忌证的情况下，神经轴麻醉可能会改善 SA 患者行关节置换术的围手术期结局。需要进一步研究以增强对神经轴麻醉可能产生相对有益效果的机制的理解。
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