Racle J P, Benkhadra A, Poy J Y, Gleizal B, Gaudray A
Ann Fr Anesth Reanim. 1986;5(1):24-30. doi: 10.1016/s0750-7658(86)80118-6.
The choice between regional versus general anaesthesia for elderly patients undergoing hip surgery is debated. It is vitally important to see if the type of anaesthetic administered affects per- and postoperative morbidity and mortality. Seventy women more than 75 yr old suitable for spinal anaesthesia were included in this study. They were randomly divided into two groups: in one (n = 35), general anaesthesia was given with sodium thiopentone, fentanyl, enflurane and vecuronium; in the other (n = 35), spinal anaesthesia was performed with 3 ml 0.5% bupivacaine in isobaric solution. During the anaesthetic period, there were no statistically significant differences between both groups in systolic arterial pressure falls or in increases in the heart rate X systolic arterial pressure product. No serious cardiovascular collapse was encountered. Seven patients (20%) receiving general anaesthesia had mental changes against four only (14.2%) in the spinal group. In patients having general anaesthesia, 22.9% developed bronchopneumonia as opposed to 8.6% in the spinal anaesthesia group (p less than 0.05). The mortality rate at three months was rather similar in the two groups. It was concluded that, in order to reduce the incidence of postoperative central dysfunction and bronchopneumonia, spinal anaesthesia should be preferred in geriatric patients for lower limb surgery.
对于接受髋关节手术的老年患者，区域麻醉与全身麻醉的选择存在争议。至关重要的是，要看看所给予的麻醉类型是否会影响围手术期和术后的发病率及死亡率。本研究纳入了70名年龄超过75岁适合脊髓麻醉的女性。她们被随机分为两组：一组（n = 35）采用硫喷妥钠、芬太尼、恩氟烷和维库溴铵进行全身麻醉；另一组（n = 35）采用3毫升等比重溶液的0.5%布比卡因进行脊髓麻醉。在麻醉期间，两组在收缩压下降或心率×收缩压乘积增加方面无统计学显著差异。未遇到严重的心血管虚脱。接受全身麻醉的7名患者（20%）出现精神改变，而脊髓麻醉组仅有4名患者（14.2%）出现。接受全身麻醉的患者中，22.9%发生支气管肺炎，而脊髓麻醉组为8.6%（p < 0.05）。两组三个月时的死亡率相当相似。得出的结论是，为了降低术后中枢功能障碍和支气管肺炎的发生率，老年患者下肢手术应首选脊髓麻醉。
