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老年髋部骨折手术中全身麻醉与区域麻醉应用的比较分析

Comparative analysis of general and regional anesthesia applications in geriatric hip fracture surgery.

作者信息

Li Ping, Li Xi, Peng Guiying, Deng Jun, Li Qiang

机构信息

Department of Anesthesiology, The People's Hospital of Yuechi County, Chengdu, Sichuan, China.

Department of Anesthesiology, Affiliated Hospital of Southwest Jiaotong University, The Third People's Hospital of Chengdu, Chengdu, China.

出版信息

Medicine (Baltimore). 2025 Jan 10;104(2):e41125. doi: 10.1097/MD.0000000000041125.

Abstract

BACKGROUND

This study compares the outcomes of general anesthesia (GA) and regional anesthesia (RA) in geriatric hip fracture surgery to determine optimal anesthesia strategies for this population.

METHODS

A comprehensive literature review was conducted, analyzing studies comparing GA and RA in elderly patients undergoing hip fracture surgery. Studies encompassed various designs, including randomized controlled trials, cohort studies, and meta-analyses. Key analytical techniques included comparative analysis of intraoperative complications, postoperative outcomes, mortality rates, and physiological impacts.

RESULTS

GA was associated with higher risks of intraoperative cardiovascular events, respiratory depression, and postoperative complications such as cognitive dysfunction and delirium. In contrast, RA demonstrated superior outcomes in pain management, early mobilization, and reduced incidences of complications like postoperative nausea and vomiting. RA also correlated with shorter hospital stays and lower mortality rates within the first 30 days post-surgery.

CONCLUSION

RA emerges as a preferable choice for geriatric hip fracture surgery, offering improved safety profiles, enhanced recovery trajectories, and better postoperative cognitive outcomes compared to GA. These findings underscore the importance of anesthesia selection in optimizing surgical outcomes and patient safety in elderly populations. Future research should focus on prospective trials to validate these results and refine anesthesia protocols tailored to elderly hip fracture patients.

摘要

背景

本研究比较了老年髋部骨折手术中全身麻醉(GA)和区域麻醉(RA)的效果,以确定该人群的最佳麻醉策略。

方法

进行了全面的文献综述,分析了比较老年髋部骨折手术患者中GA和RA的研究。研究涵盖了各种设计,包括随机对照试验、队列研究和荟萃分析。关键分析技术包括术中并发症、术后结果、死亡率和生理影响的比较分析。

结果

GA与术中心血管事件、呼吸抑制以及术后并发症如认知功能障碍和谵妄的较高风险相关。相比之下,RA在疼痛管理、早期活动以及降低术后恶心和呕吐等并发症的发生率方面表现出更好的效果。RA还与术后住院时间缩短和术后30天内较低的死亡率相关。

结论

与GA相比,RA成为老年髋部骨折手术的更优选择,具有更好的安全性、更快的恢复进程和更好的术后认知结果。这些发现强调了麻醉选择在优化老年人群手术结果和患者安全方面的重要性。未来的研究应侧重于前瞻性试验,以验证这些结果并完善针对老年髋部骨折患者的麻醉方案。

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