CAJ | 학술논문

目的：探讨全身麻醉（ general anesthesia ， GA ）和硬膜外联合蛛网膜下腔麻醉（ combined spinal epidural anesthesia， CSEA）对髋部骨折老年病人术后肺部并发症的影响。方法选择我院2005年1月～2014年12月髋部骨折接受手术治疗的老年病人469例，其中300例接受CSEA（CSEA组），169例接受GA（GA组），先对病人年龄、性别、术前内科合并症、卧床时间、手术和麻醉方式进行单因素分析，有统计学差异的因素再采用多重logistic回归模型分析老年髋部骨折病人术后肺部并发症的影响因素。结果48例发生术后肺部并发症，其中CSEA组13例，GA组35例。单因素分析显示年龄、术前卧床时间和麻醉方式有统计学差异（P＜0．05），性别、ASA分级和内科合并症无统计学差异（P＞0．05）。多重logistic回归分析显示CSEA可以降低髋部骨折老年病人的术后肺部并发症（ OR＝0．17，95％ CI：0．08～0．31，P＝0．000）；80～84岁（OR＝5．09，95％CI：1．74～14．86，P＝0．003）、85岁以上（OR＝5．27，95％ CI：1．71～16．17，P＝0．004）和术前卧床2 d以上（OR＝2.41，95％CI：1．04～5．56，P＝0．040）是发生术后肺部并发症的危险因素。结论 CSEA较GA可以降低髋部骨折老年病人的术后肺部并发症。
목적：탐토전신마취（ general anesthesia ， GA ）화경막외연합주망막하강마취（ combined spinal epidural anesthesia， CSEA）대관부골절노년병인술후폐부병발증적영향。방법선택아원2005년1월～2014년12월관부골절접수수술치료적노년병인469례，기중300례접수CSEA（CSEA조），169례접수GA（GA조），선대병인년령、성별、술전내과합병증、와상시간、수술화마취방식진행단인소분석，유통계학차이적인소재채용다중logistic회귀모형분석노년관부골절병인술후폐부병발증적영향인소。결과48례발생술후폐부병발증，기중CSEA조13례，GA조35례。단인소분석현시년령、술전와상시간화마취방식유통계학차이（P＜0．05），성별、ASA분급화내과합병증무통계학차이（P＞0．05）。다중logistic회귀분석현시CSEA가이강저관부골절노년병인적술후폐부병발증（ OR＝0．17，95％ CI：0．08～0．31，P＝0．000）；80～84세（OR＝5．09，95％CI：1．74～14．86，P＝0．003）、85세이상（OR＝5．27，95％ CI：1．71～16．17，P＝0．004）화술전와상2 d이상（OR＝2.41，95％CI：1．04～5．56，P＝0．040）시발생술후폐부병발증적위험인소。결론 CSEA교GA가이강저관부골절노년병인적술후폐부병발증。
Objective To study the effects of general anesthesia ( GA) and combined spinal epidural anesthesia ( CSEA) on postoperative pulmonary complications after hip fracture surgery in elderly patients . Methods A total of 469 eldly patients undergoing surgery for hip fracture were selected , including 300 patients receiving CSEA and 169 patients receiving GA .After univariate analysis on age , gender, preoperative co-morbidities, bedridden time, and methods of operation and anesthesia , a multiple logistic regression analysis was carried out on statistically different factors to observe influencing factors of postoperative pulmonary complications in elderly patients . Results Postoperative pulmonary complications occurred in 48 patients (10.2%).Univariate analysis showed that the independent variables on postopeative pulmonary complications were age , bedridden time, and anesthesia (P<0.05).Other factors, such as gender,ASA classification, and preoperative co-morbidities, had no statistical significance (P>0.05). Combined spinal epidural anesthesia was associated with a lower odds of pulmonary complications ( OR=0.17, 95%CI:0.08-0.31, P=0.000) as compared to general anesthesia .The age group of 80-84 years old (OR=5.09, 95%CI:1.74-14.86, P=0.003), over 85 years old (OR=5.27, 95%CI:1.71-16.17, P=0.004), and bedridden time more than 2 days (OR=2.41, 95%CI:1.04-5.56, P=0.040 ) were also the risk factors of postoperative pulmonary complications . Conclusion Combined spinal epidural anesthesia is associated with a lower odds of pulmonary complications in hip fracture patients as compared with general anesthesia .