Davis F M, Woolner D F, Frampton C, Wilkinson A, Grant A, Harrison R T, Roberts M T, Thadaka R
Christchurch Clinical School, New Zealand.
Br J Anaesth. 1987 Sep;59(9):1080-8. doi: 10.1093/bja/59.9.1080.
In a prospective randomized multi-centre study, the mortality following internal fixation surgery for fracture of the upper femur was investigated in 538 elderly patients allocated to receive subarachnoid blockade or general (narcotic-relaxant) anaesthesia. The 28-day mortality was 6.6% with subarachnoid, and 5.9% with general, anaesthesia. The difference was not significant (95% confidence limits: -3.5 to +4.8). At 1 year following surgery, the mortality was 20.4%. Increasing age, ischaemic heart disease, cardiac failure, preoperative arrhythmias and poor ASA status were all associated with increases in early and long term mortality. A delay to surgery of more than 24 h from admission was also associated with an increased 28-day mortality. Senile dementia and admission other than from the patient's own home, were factors associated with a poorer long term outcome. From the point of view of mortality, subarachnoid anaesthesia did not appear to confer any advantages over general anaesthesia in non-prosthetic surgery for hip fracture in the elderly.
在一项前瞻性随机多中心研究中，对538例分配接受蛛网膜下腔阻滞或全身（麻醉性松弛剂）麻醉的老年股骨上段骨折内固定手术患者的死亡率进行了调查。蛛网膜下腔麻醉组28天死亡率为6.6%，全身麻醉组为5.9%。差异无统计学意义（95%置信区间：-3.5至+4.8）。术后1年死亡率为20.4%。年龄增加、缺血性心脏病、心力衰竭、术前心律失常和ASA状态差均与早期和长期死亡率增加相关。入院后手术延迟超过24小时也与28天死亡率增加相关。老年痴呆症和非从患者自己家中入院是与长期预后较差相关的因素。从死亡率的角度来看，在老年髋部骨折的非假体手术中，蛛网膜下腔麻醉似乎并不比全身麻醉有任何优势。
