不同麻醉方式对全膝关节置换围术期失血量及术后并发症的影响

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Abstract Objective To evaluate the effect of combined spinal epidural anesthesia and general anesthesia，on perioperative blood loss and postoperative complications in patients undergoing initial total knee arthroplasty(TKA).Methods The medical records of 3 568 patients who underwent initial unilateral TKA at Luoyang Orthopedic Hospital in Henan Province from January 2015 to December 2019 were collected for retrospective analysis.Of these，966 patients were in the combined spinal epidural anesthesia group，with 210 males and 756 females.Their ages ranged from 45 to 85 years old，with a mean age of (66.69±7.70)years old.Additionally，2 602 patients were in the general anesthesia group，including 597 males and 2 005 females.Their ages also spanned from 46 to 85 years old，averaging (66.63±7.56)years old.We further compared the general baseline indicators，encompassing diagnosis，coexisting diseases，blood volume，preoperative hemoglobin levels，preoperative haematocrit values，surgical side，and operation time.The objective was to analyze the total perioperative blood loss，intraoperative blood loss，allogeneic transfusion rate，drainage volume，as well as changes in hemoglobin and haematocrit levels in both groups.Furthermore，we documented the occurrence of postoperative complications，such as deep vein thrombosis，pulmonary embolism，nausea and vomiting，and electrolyte imbalances.Lastly，we evaluated the duration of postoperative hospitalization，rehabilitation outcomes including knee 〖CM(50〗mobility at one month postoperatively，and the cost of inpatient treatment in both anesthesia groups.Results Theperioperative total blood loss，maximum change in haemoglobin，and maximum change in haematocrit were (743.67±546.36)mL，(27.94±17.85)g/L，and (0.14±0.05)L/L in the combined spinal epidural anesthesia group，and (800.47±564.95)mL，(29.86±17.37)g/L，and (0.14±0.06)L/L in the general anaesthesia group.The former values were lower than the latter，and the difference was statistically significant (P＜0.05).However，there was no statistically significant difference in intraoperative blood loss，allogeneic transfusion rate，and drainage volume between the two groups (P＞0.05).The postoperative hospital stay of patients in the combined spinal epidural anesthesia group was slightly shorter than that of the general anaesthesia group (P＝0.04)，while the differences between the two groups were not statistically significant in terms of joint mobility and treatment costs at 1 month after operation (P＞0.05).The incidence of postoperative complications was also not statistically significant between the two groups (P＞0.05).Conclusion In patients undergoing initial unilateral TKA，combined spinal epidural anesthesia was more advantageous in controlling total perioperative blood loss and in shortening the postoperative recovery time.However，there were no significant advantages in terms of postoperative joint mobility and postoperative complication rates.

Key words： total knee arthroplasty combined spinal epidural anesthesia general anesthesia blood loss postoperative complication

Corresponding Authors: Tan Honglue

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	Liao Yuanping
	Cao Guorui
	Shi Xiaotao
	Wang Xiao
	Deng Jie
	Wang Yixuan
	Tan Honglue

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Liao Yuanping,Cao Guorui,Shi Xiaotao, et al. Effect of Different Anesthesia Modalities on Perioperative Blood Loss and Postoperative Complications in Total Knee Arthroplasty[J]. sygkzz, 2024, 30(4): 306-.

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