新型冠状病毒肺炎疫情下创伤骨科手术麻醉方式选择的回顾性分析

目的回顾性比较2020年新型冠状病毒肺炎(COVID-19)疫情防控期间与2019年同期非疫情期间创伤骨科手术患者麻醉方式选择的异同与经验。方法回顾性分析2020年1月24日至3月1日(2020年COVID-19疫情期间)及2019年2月4日至2019月3月14日(2019年农历同期)河北医科大学第三医院创伤急救中心手术患者手术麻醉方式。两个时间段的患者又分别根据年龄将其分为≥65岁年龄组及<65岁年龄组。对比两个时期总体及各年龄段手术麻醉方式的异同及完成麻醉操作所需要的时间。结果2020年疫情期间共完成创伤骨科手术285例,与2019同期(784例)相比下降63.7%;≥65岁的老年骨折手术患者2020疫情期间占比29.5%(84/285),较2019年同期占比18.1%(142/784)明显增加。与2019年同期非气道管理麻醉的患者占比38.3%(300/784)]相比,2020年疫情期间56.5%(161/285)]显著增高,其中≥65岁年龄组患者分别为41.6%(59/142)和71.4%(60/84),两个时期比较差异均有统计学意义(P<0.05)。2020年疫情期间椎管内麻醉36.5%(104/285)]、静脉/+外周神经阻滞麻醉4.9%(14/285)]较2019年同期25.5%(200/784)、0.3%(2/784)]均显著增高,2020年疫情期间喉罩/+外周神经阻滞麻醉27.7%(79/285)]较2019年同期48.9%(383/784)]明显降低,差异均有统计学意义(P<0.05)。≥65岁年龄组患者中,2020年疫情期椎管内麻醉48.8%(41/84)]、静脉/+外周神经阻滞麻醉10.7%(9/84)]较2019年同期29.6%(42/142)、0]显著增高,2020年疫情期间喉罩/+外周神经阻滞麻醉21.4%(18/84)]较2019年同期的47.9%(68/142)]明显降低,差异均有统计学意义(P<0.05)。与2019年同期椎管内麻醉操作时间(6.2±0.4)min]及插管/+阻滞操作时间(7.4±0.4)min]相比,2020年疫情期间(12.6±0.4)min、(13.2±0.3)min]均有明显延长,差异均有统计学意义(P<0.05)。结论2020年COVID-19疫情期间,麻醉方式以不影响呼吸道的神经阻滞、椎管内麻醉、静脉麻醉等非气道管理为主,可能由于其有助于减少患者术后呼吸系统并发症,避免与COVID-19所致呼吸系统疾病相混淆;且麻醉时间较2019年同期相对较长。

Anesthesia methods for patients undergoing orthopeadic surgery in the epidemic period of COVID-19

Objective To compare the anesthesia methods for patients undergoing orthopaedic surgery between the epidemic period of COVID-19 in 2020 and the same period in 2019.Methods A retrospective study was conducted of the patients who had undergone orthopedic surgery at The Trauma Emergency Center,The Third Hospital of Hebei Medical University in the epidemic period of COVID-19 from 20 January through 1 March in 2020 and from 4 February through 14 March in 2019(the same lunar period).Their anesthesia methods were analyzed.The patients in the 2 periods were divided into a group of≥65 years old and a group of<65 years old.The anesthesia methods and anesthetic operation time were compared between the total cohorts and 2 age groups in the 2 periods.Results A total of 285 orthopedic operations were completed in the epidemic period in 2020,a decrease by 63.7%than the 784 operations in the same period in 2019;the proportion of elderly fracture patients≥65 years old in 202029.5%(84/285)]was significantly higher than that18.1%(142/784)]in 2019.The proportion of non-airway management anesthesia in the epidemic period in 202056.5%(161/285)]was significantly higher than that in the same period in 201938.3%(300/784)];there was a significant difference in the proportion of non-airway management anesthesia for elderly patients≥65 years old between the 2 periods41.6%(59/142)versus 71.4%(60/84)](P<0.05).The proportions of intraspinal anesthesia36.5%(104/285)]and intravenous/+peripheral nerve block anesthesia4.9%(14/285)]in 2020 were significantly higher than those in 201925.5%(200/784)and 0.3%(2/784)](P<0.05);the proportion of laryngeal mask/+peripheral nerve block anesthesia in 202027.7%(79/285)]was significantly lower than that in 201948.9%(383/784)](P<0.05).In the group of≥65 years old,the proportions of intraspinal anesthesia48.8%(41/84)]and intravenous/+peripheral nerve block anesthesia10.7%(9/84)]in 2020 were significantly higher than those in 201929.6%(42/142)and 0](P<0.05),but the proportion of laryngeal mask/+peripheral nerve block anesthesia in 202021.4%(18/84)]was significantly lower than that in 201947.9%(68/142)](P<0.05).Compared with the operation time for intraspinal anesthesia(6.2 min±0.4 min)and for intubation/+block anesthesia(7.4 min±0.4 min)in 2019,the operation time in 2020(12.6 min±0.4 min and 13.2 min±0.3 min,respectively)was significantly increased(P<0.05).Conclusions The anesthesia methods for patients undergoing orthopaedic surgery in the epidemic period in 2020 were featured by non-airway management like peripheral nerve block anesthesia,intraspinal anesthesia,and laryngeal mask/+peripheral nerve block anesthesia because they might have helped to reduce the postoperative complications in respiratory system.The anesthetic operation time in the epidemic period in 2020 was increased than in the same period in 2019.