不同麻醉方式对高海拔地区老年下肢骨科手术患者术后并发症的影响
Effects of Different Anesthesia Methods on Postoperative Complications in Elderly Patients Undergoing Lower Limb Orthopedic Surgery at High Altitudes
DOI: 10.12677/ACM.2023.1351078, PDF,   
作者: 朱雪琴：青海大学研究生院，青海 西宁 ；王 云：青海省人民医院麻醉科，青海 西宁
关键词: 高海拔地区；麻醉；老年患者；骨科手术；术后并发症；High Altitudes； Anaesthesia； Elderly Patients； Orthopedic Surgery； Postoperative Complications
摘要: 老年(≥60岁)患者因行动不便，易发生骨折。因各种脏器功能和内环境稳定性的减退，多数属于高危患者，术后并发症发生率较高，主要是贫血、低蛋白血症、低钾血症、肺部感染等。对于老年患者行骨科手术，可采用不同的麻醉方法。年龄并不是手术和麻醉的禁忌证，但是由于自身并存的疾病，衰老过程中发生器官生理构造、功能改变的影响，老年患者围术期的并发症发生率及死亡率显著地高于青壮年。本文旨在三种麻醉方式对老年下肢骨科手术患者术后并发症的影响作一综述，为此类患者的麻醉选择提供一定的参考。
Abstract: Elderly (≥60 years old) patients are prone to fractures due to mobility difficulties. Due to the de-cline of various organ functions and internal environmental stability, most of them are high-risk pa-tients, and the incidence of postoperative complications is high, mainly anemia, hypoproteinemia, hypokalemia, lung infection, etc. For orthopedic surgery in older patients, different methods of an-esthesia can be used. Age is not a contraindication to surgery and anesthesia, but due to its own co-existing diseases, the physiological structure and function of organs occur in the aging process, and the perioperative complication rate and mortality rate of elderly patients are significantly higher than those in young adults. This article aims to review the effects of the three anesthesia methods on postoperative complications in elderly patients undergoing orthopedic surgery of lower extrem-ities, and provide a certain reference for the choice of anesthesia in such patients.
文章引用：朱雪琴, 王云. 不同麻醉方式对高海拔地区老年下肢骨科手术患者术后并发症的影响[J]. 临床医学进展, 2023, 13(5): 7714-7722. https://doi.org/10.12677/ACM.2023.1351078

参考文献

[1] Corcoran, T.B. and Hillyard, S. (2011) Cardiopulmonary Aspects of Anaesthesia for the Elderly. Best Practice & Re-search Clinical Anaesthesiology, 25, 329-354. [Google Scholar] [CrossRef] [PubMed]
[2] Coburn, M., Röhl, A.B., Knobe, M., et al. (2016) Anesthesiological Management of Elderly Trauma Patients. Der Anaesthesist, 65, 98-106. [Google Scholar] [CrossRef] [PubMed]
[3] Pauley, E., Orgel, R., Rossi, J.S. and Strassle, P.D. (2019) Age-Stratified National Trends in Pulmonary Embolism Admissions. CHEST, 156, 733-742. [Google Scholar] [CrossRef] [PubMed]
[4] Mallet, R.T., Burtscher, J., Richalet, J.P., Millet, G.P. and Burtscher, M. (2021) Impact of High Altitude on Cardiovascular Health: Current Perspectives. Vascular Health and Risk Management, 17, 317-335. [Google Scholar] [CrossRef] 
[5] Aksoy, M., Ince, I., Ahıskalıoglu, A., et al. (2015) Spinal Anaesthe-sia at Low and Moderately High Altitudes: A Comparison of Anaesthetic Parameters and Hemodynamic Changes. BMC Anesthesiology, 15, Article No. 123. [Google Scholar] [CrossRef] [PubMed]
[6] Tinubu, J. and Scalea, T.M. (2015) Management of Fractures in a Geriatric Surgical Patient. Surgical Clinics of North America, 95, 115-128. [Google Scholar] [CrossRef] [PubMed]
[7] Zhang, F., Zhang, R., He, L., et al. (2017) Effects of Preoperative Chronic Hypoxemia on Geriatrics Outcomes after Hip Arthroplasty: A Hospital-Based Retrospective Analysis Study. Medicine, 96, e6587. [Google Scholar] [CrossRef] 
[8] Neuman, M.D., Feng, R., Carson, J.L., et al. (2021) Spinal Anesthesia or General Anesthesia for Hip Surgery in Older Adults. New England Journal of Medicine, 385, 2025-2035. [Google Scholar] [CrossRef] 
[9] Elkassabany, N.M., Abraham, D., Huang, S., et al. (2017) Patient Education and Anesthesia Choice for Total Knee Arthroplasty. Patient Education and Counseling, 100, 1709-1713. [Google Scholar] [CrossRef] [PubMed]
[10] Guay, J., Parker, M.J., Griffiths, R. and Kopp, S. (2017) Peripheral Nerve Blocks for Hip Fractures. Cochrane Database of Systematic Reviews, No. 5, Article No. CD001159. [Google Scholar] [CrossRef] 
[11] Oliver-Fornies, P., Espinosa Morales, K., Fajardo-Pérez, M., et al. (2022) Modified Supraclavicular Approach to Brachial Plexus Block. Journal of Clinical Anesthesia, 76, Arti-cle ID: 110585. [Google Scholar] [CrossRef] [PubMed]
[12] Fu, G., Li, H., Wang, H., et al. (2021) Comparison of Periph-eral Nerve Block and Spinal Anesthesia in Terms of Postoperative Mortality and Walking Ability in Elderly Hip Fracture Patients—A Retrospective, Propensity-Score Matched Study. Clinical Interventions in Aging, 16, 833-841. [Google Scholar] [CrossRef] 
[13] Finsterwald, M., Muster, M., Farshad, M., et al. (2018) Spinal versus General Anesthesia for Lumbar Spine Surgery in High Risk Patients: Perioperative Hemodynamic Stability, Complica-tions and Costs. Journal of Clinical Anesthesia, 46, 3-7. [Google Scholar] [CrossRef] [PubMed]
[14] Bhushan, S., Huang, X., Duan, Y. and Xiao, Z. (2022) The Impact of Regional versus General Anesthesia on Postoperative Neurocognitive Outcomes in Elderly Patients Undergo-ing Hip Fracture Surgery: A Systematic Review and Meta-Analysis. International Journal of Surgery, 105, Article ID: 106854. [Google Scholar] [CrossRef] [PubMed]
[15] Cwik, J. (2012) Postoperative Considerations of Neuraxial Anesthesia. Anesthesiology Clinics, 30, 433-443. [Google Scholar] [CrossRef] [PubMed]
[16] Soffin, E.M. and Memtsoudis, S.G. (2018) Anesthesia and An-algesia for Total Knee Arthroplasty. Minerva Anestesiologica, 84, 1406-1412. [Google Scholar] [CrossRef] 
[17] Joshi, G., Gandhi, K., Shah, N., et al. (2016) Peripheral Nerve Blocks in the Management of Postoperative Pain: Challenges and Opportunities. Journal of Clinical Anesthesia, 35, 524-529. [Google Scholar] [CrossRef] [PubMed]
[18] Bouche, P. (2020) Neuropathy of the Elderly. Revue Neurologique, 176, 733-738. [Google Scholar] [CrossRef] [PubMed]
[19] Leary, M.C. and Varade, P. (2020) Perioperative Stroke. Current Neurology and Neuroscience Reports, 20, Article No. 12. [Google Scholar] [CrossRef] [PubMed]
[20] Liu, X., Ji, J. and Zhao, G.-Q. (2020) General Anesthesia Affecting on Developing Brain: Evidence from Animal to Clinical Research. Journal of Anesthesia, 34, 765-772. [Google Scholar] [CrossRef] [PubMed]
[21] Kreuer, S. and Hüppe, T. (2017) Das Zentralnervensystem (ZNS) als Zielorgan der Allgemeinanästhesie [The Central Nervous System as the Target Organ of General Anesthesia]. Der Anaesthesist, 66, 643-644. [Google Scholar] [CrossRef] [PubMed]
[22] Yokose, M., Takaki, R., Mihara, T., et al. (2022) Hypotension af-ter General Anesthesia Induction Using Remimazolam in Geriatric Patients: Protocol for a Double-Blind Randomized Controlled Trial. PLOS ONE, 17, e0275451. [Google Scholar] [CrossRef] [PubMed]
[23] Li, J., Krishna, R., Zhang, Y., Lam, D. and Vadivelu, N. (2020) Ultrasound-Guided Neuraxial Anesthesia. Current Pain and Headache Reports, 24, Article No. 59. [Google Scholar] [CrossRef] [PubMed]
[24] Boselli, E., Hopkins, P., Lamperti, M., et al. (2021) European Society of Anaesthesiology and Intensive Care Guidelines on Peri-Operative Use of Ultrasound for Regional Anaesthesia (PERSEUS Regional Anesthesia): Peripheral Nerves Blocks and Neuraxial Anaesthesia. European Journal of Anaesthe-siology, 38, 219-250. [Google Scholar] [CrossRef] 
[25] Barrington, M.J. and Snyder, G.L. (2011) Neurologic Com-plications of Regional Anesthesia. Current Opinion in Anaesthesiology, 24, 554-560. [Google Scholar] [CrossRef] 
[26] Alvis, B.D. and Hughes, C.G. (2015) Physiology Consider-ations in Geriatric Patients. Anesthesiology Clinics, 33, 447-456. [Google Scholar] [CrossRef] [PubMed]
[27] Cho, S.J. and Stout-Delgado, H.W. (2020) Aging and Lung Dis-ease. Annual Review of Physiology, 82, 433-459. [Google Scholar] [CrossRef] [PubMed]
[28] Santer, P., Wachtendorf, L.J., Suleiman, A., et al. (2022) Mechanical Power during General Anesthesia and Postoperative Respiratory Failure: A Multicenter Retrospective Cohort Study. Anesthesiology, 137, 41-54. [Google Scholar] [CrossRef] 
[29] Neto, A.S., Hemmes, S.N., Barbas, C.S., et al. (2016) As-sociation between Driving Pressure and Development of Postoperative Pulmonary Complications in Patients Undergoing Mechanical Ventilation for General Anaesthesia: A Meta-Analysis of Individual Patient Data. The Lancet Respiratory Medicine, 4, 272-280. [Google Scholar] [CrossRef] 
[30] Bigatello, L. and Pesenti, A. (2019) Respiratory Physiology for the Anesthesiologist. Anesthesiology, 130, 1064-1077. [Google Scholar] [CrossRef] 
[31] Zhan, L., Zhang, Y.-J. and Wang, J.-X. (2021) Combined Fascia Iliaca Compartment Block and Monitored Anesthesia Care for Geriatric Patients with Hip Fracture: Two Case Reports. World Journal of Clinical Cases, 9, 8268-8273. [Google Scholar] [CrossRef] [PubMed]
[32] Chen, D.X., Yang, L., Ding, L., et al. (2019) Perioperative Out-comes in Geriatric Patients Undergoing Hip Fracture Surgery with Different Anesthesia Techniques: A Systematic Re-view and Meta-Analysis. Medicine, 98, e18220. [Google Scholar] [CrossRef] 
[33] Baker, M.D. and Gullett, J.P. (2015) Ultrasound-Guided Femoral Nerve Blocks. Pediatric Emergency Care, 31, 864-868. [Google Scholar] [CrossRef] 
[34] Crooke, S.N., Ovsyannikova, I.G., Poland, G.A. and Ken-nedy, R.B. (2019) Immunosenescence: A Systems-Level Overview of Immune Cell Biology and Strategies for Improv-ing Vaccine Responses. Experimental Gerontology, 124, Article ID: 110632. [Google Scholar] [CrossRef] [PubMed]
[35] Zheng, X., Tan, Y., Gao, Y. and Liu, Z. (2020) Comparative Ef-ficacy of Neuraxial and General Anesthesia for Hip Fracture Surgery: A Meta-Analysis of Randomized Clinical Trials. BMC Anesthesiology, 20, Article No. 162. [Google Scholar] [CrossRef] [PubMed]
[36] Yeung, B.G., Ma, M.W., Scolaro, J.A. and Nelson, A.M. (2022) Cannabis Exposure Decreases Need for Blood Pressure Support During General Anesthesia in Orthopedic Trauma Sur-gery. Cannabis and Cannabinoid Research, 7, 328-335. [Google Scholar] [CrossRef] [PubMed]
[37] Liu, J., Zhong, H., DeMeo, D., et al. (2021) Controlled Hypotension during Neuraxial Anesthesia Is Not Associated with Increased Odds of In-Hospital Common Severe Medical Complications in Patients Undergoing Elective Primary Total Hip Arthro-plasty—A Retrospective Case Control Study. PLOS ONE, 16, e0248419. [Google Scholar] [CrossRef] [PubMed]
[38] Weinstein, S.M., YaDeau, J.T. and Memtsoudis, S.G. (2018) Lack of Association between Levels and Length of Intraoperative Controlled Hypotension and Acute Kidney Injury in Total Hip Arthroplasty Patients Receiving Neuraxial Anesthesia. Regional Anesthesia & Pain Medicine, 43, 725-731. [Google Scholar] [CrossRef] 
[39] Gadsden, J., McCally, C. and Hadzic, A. (2010) Monitoring during Peripheral Nerve Blockade. Current Opinion in Anaesthesiology, 23, 656-661. [Google Scholar] [CrossRef] 
[40] Kratz, T., Dette, F., Schmitt, J., et al. (2015) Impact of Re-gional Femoral Nerve Block During General Anesthesia for Hip Arthoplasty on Blood Pressure, Heart Rate and Pain Control: A Randomized Controlled Study. Technology and Health Care, 23, 313-322. [Google Scholar] [CrossRef] 
[41] Moreno, I., Tsamassiottis, S., Ettinger, M., Fischer-Kumbruch, M. and Przemeck, M. (2022) Original Paper Femoral Nerve Blockade versus Local Infiltration Analgesia for Primary Knee Ar-throplasty. Randomised Controlled Trial. Anaesthesiology Intensive Therapy, 54, 387-392. [Google Scholar] [CrossRef] [PubMed]
[42] Guay, J., Parker, M.J., Gajendragadkar, P.R. and Kopp, S. (2016) Anaesthesia for Hip Fracture Surgery in Adults. Cochrane Database of Systematic Reviews, No. 2, Article No. CD000521. [Google Scholar] [CrossRef] 
[43] Akcan, A., Şanal Baş, S. and Güleç, M.S. (2020) Effect of Regional or General Anesthesia Methods on Mortality According to Age Groups in Geriatric Hip Surgery Patients. AGRI, 32, 72-78. [Google Scholar] [CrossRef] [PubMed]
[44] Scurrah, A., Shiner, C.T., Stevens, J.A. and Faux, S.G. (2018) Regional Nerve Blockade for Early Analgesic Management of Elderly Patients with Hip Fracture—A Narrative Review. Anaesthesia, 73, 769-783. [Google Scholar] [CrossRef] [PubMed]
[45] Lim, B.-G. and Lee, I.-O. (2020) Anesthetic Management of Geriatric Pa-tients. Korean Journal of Anesthesiology, 73, 8-29. [Google Scholar] [CrossRef] [PubMed]

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