不同麻醉方式对髋部骨折手术患者围手术期预后的影响：系统评价和荟萃分析

贵州医科大 麻醉与心脏电生理课题组

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翻译：柏雪 编辑：柏雪 审校：曹莹

背景：以往关于全身麻醉和区域麻醉对成年髋部骨折患者围手术期影响的研究并未得出一致的结果。本系统回顾和荟萃分析的目的是比较全身麻醉和区域麻醉对髋部骨折手术患者预后影响。

方法：我们进行了一项系统回顾和荟萃分析，以比较全身麻醉和区域麻醉对成人髋部骨折患者（≥ 18 岁）的住院死亡率、30 天死亡率、术后肺炎和谵妄的影响。在2022 年 1 月 1 日至 2023 年 3 月 31 日期间，对 PubMed、Ovid Medline、Cochrane 图书馆和 Scopus 中的回顾性观察和前瞻性随机对照研究进行了系统检索。

结果：21项研究，包括 363 项，与区域麻醉相比，全身麻醉组的 470 名患者住院死亡率更高（OR = 1.21；95% CI 1.13–1.29；P < 0.001，n = 191,511）。两组的30 天死亡率（OR = 1.00；95% CI 0.96–1.05；P = 0.95，n = 163,811），术后肺炎发生率（OR = 0.93；95% CI 0.82–1.06；P = 0.28，n = 36,743 ) 和术后谵妄发生率 (OR = 0.94；95% CI 0.74–1.20；P = 0.61，n = 2861) 无显著差异。

结论：区域麻醉可降低住院死亡率。然而，麻醉方式对30天死亡率、术后肺炎和谵妄的发生没有影响。未来需要大量的随机研究来检验麻醉方式、术后并发症和死亡率之间的关系。

原始文献来源：Bo Ma1, Haibiao Xie2, Huayong Ling, Wuhua Ma, et, al. Perioperative outcomes in different anesthesia techniques for patients undergoing hip fracture surgery: a systematic review and meta-analysis. Ma et al. BMC Anesthesiology (2023) 23:184

英文原文：

Perioperative outcomes in different anesthesia techniques for patients undergoing hip fracture surgery: a systematic review and meta-analysis

Abstract

Background Previous studies of the perioperative effects of general and regional anesthesia in adult patients undergoing effects of different anesthesia techniques on patients undergoing hip fracture surgery have not produced consistent results. The aim of this systematic review and meta-analysis was to compare the hip fracture surgery.

Methods We performed a systematic review and meta-analysis to compare the effects of general anesthesia with regional anesthesia on in-hospital mortality, 30-day mortality, postoperative pneumonia, and delirium in adult hip fracture patients (≥ 18 years). Between January 1, 2022, and March 31, 2023, a systematic search was performed for retrospective observational and prospective randomized controlled studies in PubMed, Ovid Medline, Cochrane Library, and Scopus.

Results Twenty-one studies including 363,470 patients showed higher in-hospital mortality in the general anesthesia group compared with regional anesthesia (OR = 1.21; 95% CI 1.13–1.29; P < 0.001, n = 191,511). The 30-day mortality (OR = 1.00; 95% CI 0.96–1.05; P = 0.95, n = 163,811), the incidence of postoperative pneumonia (OR = 0.93; 95% CI 0.82–1.06; P = 0.28, n = 36,743) and the occurrence of postoperative delirium in the two groups (OR = 0.94; 95% CI 0.74–1.20; P = 0.61, n = 2861) had no significant difference.

Conclusion Regional anesthesia is associated with reduced in-hospital mortality. However, the type of anesthesia did not affect the occurrence of 30-day mortality, postoperative pneumonia, and delirium. A large number of randomized studies are needed in the future to examine the relationship between type of anesthesia, postoperative complications, and mortality.

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