颈神经后支阻滞麻醉用于颈椎后路手术的可行性研究  

Feasibility of cervical dorsal rami nerve block in posterior approach of cervical vertebra operation

作　　者：苗韶华[1] 戴燕雪[2] 王海峰[1] 

机构地区：[1]山东省菏泽市立医院麻醉科,274031 [2]山东省菏泽市立医院CT室

出　　处：《中国医师进修杂志》2008年第10期12-15,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的 探讨颈神经后支阻滞麻醉用于颈椎后路手术中的有效性和安全性。方法86例拟行颈椎后路手术的患者，ASA分级Ⅰ-Ⅱ级，随机均分为两组：颈神经后支阻滞麻醉组（Ⅰ组）和局部浸润麻醉组（Ⅱ组）。Ⅰ组根据颈神经后支的局部解剖特点，术前通过测量颈椎X线片，确定颈椎关节突关节腰部体表投影点，经皮穿刺阻滞手术切口相对应的双侧脊神经后支而麻醉颈项部；Ⅱ组采用传统的局部浸润麻醉。观察两组术中麻醉效果和麻醉作用时间，对呼吸、血流动力学和SpO2的影响，术后12、24、48h疼痛评分与镇静评分以及不良反应。结果Ⅰ组麻醉优率（74％）明显高于Ⅱ组（42％）（P〈0．05），Ⅰ组手术时间少于Ⅱ组，但差异无统计学意义（P〉0．05）；Ⅰ组麻醉药用量明显低于Ⅱ组（P〈0．01）。两组麻醉后和椎管探查时平均动脉压均升高，且Ⅱ组明显高于Ⅰ组（P〈0．05）；两组SpO2均〉95％；术后24、48h的VASI组显著低于Ⅱ组（P〈0．05）；两组无严重麻醉不良反应。结论颈椎的后路手术施行颈神经后支阻滞麻醉，与其他麻醉方法相比，具有操作简便、麻醉药用量少、麻醉效果确切、对血流动力学影响轻微，降低脊髓及脊神经根损伤几率等优势，是安全可行的。Objective To probe the validity and security of cervical dorsal rami nerve block in posterior approach of cervical vertebra surgery. Methods Eighty-six adults ASA class Ⅰ - Ⅱ patients undergoing posterior approach of cervical spine operation randomized equally to cervical dorsal rami nerve block group （group Ⅰ）and partial infiltration anesthesia group （group Ⅱ ）. In group Ⅰ , according to regional anatomy characteristic of the nerve and by means of preoperatively measuring the cervical vertebra X -ray , the body surface projection of articular process joint waist of cervical vertebra were calibrated. Away 3 cm from latter median line, percutaneous puncture via 45° angle relative into sagittal plane ,adopting long 8 cm 76# needle and anesthetic to block the surgical incision corresponding bilateral dorsal rami nerves. In group Ⅱ, using traditional local infiltration anesthesia. The effect and response time of anesthesia, influence on breathing and hemodynamics or pulse oxygen saturation,visual analogue score （VAS） and calmed grade postoperatively and adverse reaction were observed and recorded. Results The anesthesia excellent rate （74%） in group Ⅰ was obviously higher than that（42%） in group Ⅱ （P〈 0.05）. The surgeries average time in group Ⅰ was less than that in group Ⅱ, but no statistical significance （P 〉 0.05 ）. The average dose of anesthetic in group Ⅰ was obviously lower than that in group Ⅱ （P〈 0.01 ）. The mean arterial pressure elevated after anesthesia in both groups, and in group Ⅰ was significantly lower than that in group Ⅱ （P 〈 0.05 ）.The SpO2 of both 〉 95%. Calmed grade and VAS at 24 and 48 h postoperatively were significantly lower in group Ⅰ than that in group Ⅱ （P 〈 0.05）. There was no adverse reactions. Conclusions Compared to other anesthesia methods in posterior approach of cervical vertebra surgery, the method of cervical dorsal rami nerve block has so undermentioned dominances： simple, less anesthetic, exa

关 键 词：可行性研究 颈椎手术 后路 颈神经后支 阻滞麻醉 

分 类 号：R614[医药卫生—麻醉学] R687[医药卫生—外科学]