【摘要】 [目的]评估不同麻醉方式对髋部骨折患者围手术期失血、住院时间和相关费用的影响,为髋部骨折围手术期治疗提供一定的参考。[方法]回顾性分析2012年4月~2014年4月502例连续就诊于本院创伤骨科的股骨转子间骨折患者,其中资料完整409例。按照麻醉方式的不同,分为全麻组(83例)和椎管内麻醉组(326例)。收集信息包括一般资料、手术时间、入院及术后第1 d时血常规检查、围手术期输血量、基础疾病、住院时间、麻醉方式和住院期间并发症。采用Gross方程计算围手术期总失血量和隐性失血量。[结果]409例患者纳入统计分析。椎管内麻醉组术中失血量为(141.7±110.7)ml明显低于全麻组(242.0±235.1)ml(P=0.001)(P<0.05)。同时椎管内麻醉组隐性失血量(P=0.001)和总失血量(P=0.001)明显低于全麻组(P<0.05)。椎管内麻醉组血红蛋白和红细胞压积变化分别为(23.8±16.5)g/L和(6.9±4.8)%。全麻组血红蛋白和红细胞压积变化分别为(35.1±14.8)g/L和(10.5±4.1)%,明显高于椎管内麻醉组(P=0.001)(P<0.05)。椎管内麻醉组输血费用明显低于全麻组(P=0.042)(P<0.05),但两组之间麻醉费用(P=0.639)、手术费用(P=0.163)和总费用(P=0.067)无明显差异(P>0.05)。两组之间住院期间并发症发生率无显著差异(P>0.05)。[结论]同全麻相比,椎管内麻醉可以减少围手术期失血量、输血量和输血相关费用;麻醉方式的选择同住院时间、住院期间并发症和住院费用无关。更多还原

【Abstract】 [Objective]To assess the influence of anaesthesia method on the perioperative blood loss,transfusion requirement,hospital stay and cost for patients with intertrochanteric fracture. [Method]From April 2012 to April 2014,502 consecutive intertrochanteric fracture patients were recruited into the present study. The patients were divided into two groups,including the spinal anesthesia( SA) and general anesthesia( GA) groups. The general data,operating time,the blood routine examination at admission and at the first day postoperatively,perioperative transfusion,basic medical diseases,hospital stay and cost,anesthesia method and complications in hospital were recorded. We calculated the total and hidden blood loss according to the Gross equation. [Result]The data regarding a total number of 409 patients was included in the final analysis. Observed intra- operative blood loss in the SA group was( 141. 7 ± 110. 7) ml,which was significantly lower than that in the GA group( 242. 0 ± 235. 1)ml( P = 0. 001). Meanwhile,hidden blood loss and total blood loss in the SA group was statistically lower than that in the GA group( P = 0. 001). Change of HGB and HCT in the SA group was( 23. 8 ± 16. 5) g / L and( 6. 9 ± 4. 8) %( P = 0. 001) respectively. Compared with the ones in the SA group,change of HGB and HCT in the GA group [( 35. 1 ± 14. 8) g / L and( 10. 5 ± 4.1) %] was significantly larger( P = 0. 001). Furthermore,the transfusion cost in the SA group was lower than that in the GA group( P = 0. 042),but there was no significant difference for the anesthesia( P = 0. 639),operation( P = 0. 163) and total cost( P = 0. 067) between the two groups. For the medical complications in hospital,there was no significant difference between thetwo groups( P > 0. 05). [Conclusion]Compared with the general anaesthesia, spinal anesthesia can reduce the perioperative blood loss,transfusion requirement and cost related to transfusion. Furthermore,the choice of anesthesia exerts no influence on the hospitalization time,medical complications in hospital and hospital- related cost.更多还原