比较脊柱麻醉和全身麻醉在老年髋部骨折手术中的效果：随机临床试验的荟萃分析。

Comparing the Effect of Spinal and General Anesthesia for Hip Fracture Surgery in Older Patients: A Meta-analysis of Randomized Clinical Trials.

机构信息

Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China.

Department of Neurology, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China.

出版信息

Orthop Surg. 2023 Dec;15(12):3254-3262. doi: 10.1111/os.13895. Epub 2023 Sep 27.

DOI:10.1111/os.13895

PMID:37753546

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10693995/

Abstract

OBJECTIVE

Hip fractures are the most common fractures among older adults, with most patients undergoing surgery. The debate regarding the type of anesthetic technique for hip fracture surgery is still ongoing. This meta-analysis aimed to compare the intraoperative and postoperative outcomes of spinal and general anesthesia in older patients undergoing hip fracture surgery.

METHODS

Eligible studies that compared the effects of spinal and general anesthesia were systematically searched from PubMed, Embase, and the Cochrane Library until May 27, 2022. The intraoperative and postoperative outcomes of the two anesthesia techniques were compared. Quality assessment, heterogeneity analysis, and publication bias of the studies were also assessed.

RESULTS

Nine articles of methodological quality were included in the meta-analysis. The pooled results revealed that there were significant differences in hypotension (risk ratio [RR] (95% confidence interval [CI]) = 0.81 (0.68, 0.97), p = 0.02) and ephedrine dose (weighted mean difference [WMD] [95%CI] = -20.94 [-37.50, -4.37] mg, p = 0.01) between the spinal and general anesthesia groups. However, no significant differences were observed in the use of ephedrine (RR [95% CI] = 0.77 [0.19, 3.05]), blood loss (WMD [95%CI] = -34.38 [-89.56, 20.80) mL], myocardial infarction (RR [95% CI] = 0.78 [0.31, 1.94] mL), heart failure (RR [95% CI] = 0.87 [0.17, 4.36] mL), stroke (RR [95%CI) = 0.65 [0.22, 1.95] mL), postoperative nausea and vomiting (RR [95% CI] = 0.88 [0.17, 4.35] mL), delirium (RR [95% CI] = 1.08 [0.89, 1.31] mL), and mortality (RR [95% CI] = 1.10 [0.72, 1.68] mL) (all p < 0.05). No publication bias was observed in any of the included studies.

CONCLUSION

Compared to general anesthesia, spinal anesthesia was associated with a lower risk of intraoperative hypotension and lower doses of ephedrine in older patients undergoing hip fracture surgery.

摘要

目的

髋部骨折是老年人中最常见的骨折类型，大多数患者需要接受手术治疗。关于髋部骨折手术麻醉技术类型的争论仍在继续。本荟萃分析旨在比较脊柱麻醉和全身麻醉在老年髋部骨折手术患者中的术中及术后结局。

方法

系统检索 PubMed、Embase 和 Cochrane 图书馆，直到 2022 年 5 月 27 日，以获取比较脊柱麻醉和全身麻醉效果的研究。比较两种麻醉技术的术中及术后结局。还评估了研究的质量评估、异质性分析和发表偏倚。

结果

纳入了 9 篇方法学质量较高的研究进行荟萃分析。汇总结果显示，在低血压（风险比[RR]（95%置信区间[CI]）= 0.81（0.68，0.97），p=0.02）和麻黄碱剂量（加权均数差[WMD] [95%CI] = -20.94 [-37.50，-4.37]mg，p=0.01）方面，脊柱麻醉组与全身麻醉组存在显著差异。然而，在使用麻黄碱（RR [95% CI] = 0.77 [0.19，3.05]）、出血量（WMD [95%CI] = -34.38 [-89.56，20.80）mL）、心肌梗死（RR [95% CI] = 0.78 [0.31，1.94]）、心力衰竭（RR [95% CI] = 0.87 [0.17，4.36]）、中风（RR [95%CI）= 0.65 [0.22，1.95]）、术后恶心呕吐（RR [95% CI] = 0.88 [0.17，4.35]）、谵妄（RR [95% CI] = 1.08 [0.89，1.31]）和死亡率（RR [95% CI] = 1.10 [0.72，1.68]）方面，两组间无显著差异（均 p<0.05）。纳入的研究均无发表偏倚。