不同麻醉方法对老年患者行下肢缺血手术术后转归的影响

Effects of different anesthetic methods on outcomes in elderly with lower extremity ischemia after surgical treatment

摘要:

目的 比较全身麻醉(GA) 和区域阻滞麻醉(RA) 对下肢缺血行手术治疗的老年患者术后转归的影响。方法 回顾性分析2013年1月至2021年3月中国医学科学院北京协和医院血管外科收治的下肢缺血行手术治疗的56例老年患者的临床资料,根据麻醉方法分为GA组(n=28)和RA组(n=28)。记录患者性别、年龄、改良心脏风险指数(RCRI)、麻醉方法、术中血流动力学指标、术后住院时间(LOS)及术后并发症。采用SPSS 19.0 统计软件进行数据分析。应用多因素logistic回归或线性回归分析不同麻醉方法对下肢缺血行手术治疗老年患者非心脏手术后心肌损伤(MINS)、术中血压波动及术后LOS的影响。结果 56例患者中18例(32.1%)发生MINS, RA组12例(42.9%),GA组6例(21.4%)。2组患者MINS发生率及术后LOS比较,差异无统计学意义(均P＞0.05)。RA组患者术中血压波动显著低于GA组,差异有统计学意义(P＜0.05)。女性是下肢缺血老年患者术后发生MINS的独立危险因素(OR=0.191,95%CI 0.051～0.720；P=0.015),麻醉方式不是影响MINS及LOS的危险因素,RA组术中血流动力学较GA组更加稳定。结论 女性是下肢缺血患者术后发生MINS的独立危险因素,麻醉方式对MINS的发生和术后LOS无显著影响,但RA组患者术中血流动力学更加平稳。

Abstract:

Objective To compare the effects of general anesthesia (GA) versus regional block anesthesia (RA) on the postoperative outcome in the elderly patients with lower limb ischemia. Methods The clinical data of 56 elderly patients with lower extremity ischemia surgically treated in our hospital from January 2013 to March 2021 were collected and analyzed retrospectively. The patients were divided into GA group (n=28) and RA group (n=28) according to the anesthesia method they underwent. The gender, age, modified cardiac risk index (RCRI), anesthesia method, intraoperative hemodynamic indexes postoperative length of hospital stay (LOS), and incidence of postoperative complications were recorded and compared between the 2 groups. SPSS statistics 19.0 was used for data analysis. Multivariate logistic regression or linear regression analysis was used to analyze the effects of different anesthesia methods on myocardial injury (MINS), intraoperative blood pressure fluctuation and postoperative LOS in the patients. Results Among the 56 patients, 18 (32.1%) developed MINS, including 12 (42.9%) in the RA group and 6 (21.4%) in the GA group. But there were no significant differences in the incidence of MINS and postoperative LOS between the 2 groups (both P>0.05). The fluctuation of intraoperative blood pressure was significantly lower in the RA group than the GA group (P<0.05). Female was an independent risk factor for postoperative MINS in the patients (OR=0.191,95%CI 0.051－0.720; P=0.015). Anesthesia mode was not a risk factor affecting MINS and LOS. The RA group had more stable intraoperative hemodynamics than the GA group. Conclusion Female is an independent risk factor for postoperative MINS in the elderly patients with lower limb ischemia. Anesthesia mode has no significant effect on the occurrence of MINS and post-operative LOS, but the hemodynamics in RA group is more stable.