椎间孔镜手术中两种硬膜外给药方案的比较研究  

Comparison of two epidural dosage regimens in percutaneous transforaminal endoscopic discectomy

作　　者：方敏波 邬晓雷[1] 桑裴铭[2] 潘志浩[1] FANG Minbo;WU Xiaolei;SANG Peiming;PAN Zhihao(Department of Anesthesiology, Ningbo City Medical Treatment Center Lihuili Hospital, Ningbo 31＇5004 ,China;Department of Orthopaedics, Ningbo City Medical Treatment Center Lihuili Hospital, Ningbo 315004, China)

机构地区：[1]宁波市医疗中心李惠利医院麻醉科,浙江宁波315004 [2]宁波市医疗中心李惠利医院骨科,浙江宁波315004

出　　处：《中国现代医生》2018年第12期106-109,共4页China Modern Doctor

基　　金：浙江省宁波市医学科技项目(2017A44)

摘　　要：目的比较不同硬膜外麻醉给药方案在椎间孔镜微创手术的麻醉效果。方法选取椎间镜治疗腰椎间盘突出髓核摘除术的患者40例,随机分为两组(每组20例):A组患者硬膜外给予0.25%罗哌卡因10 mL,B组患者硬膜外给予舒芬太尼5μg和0.25%罗哌卡因10 mL。记录两组患者术前(T0)、手术切皮(T1)、扩张通道(T2)、刺激神经根(T3)、摘除髓核(T4)手术结束(T5)等各时段的血压、心率、VAS评分。并随访记录术后1个月VAS评分,患者满意度以及手术相关并发症。术后疗效满意情况评价采用Oswestry功能障碍指数。结果 B组患者在T3及T4时间点MAP及HR明显低于A组(P<0.05),B组患者的舒芬太尼用量以及术中VAS评分明显低于A组(P<0.05)。两组患者均未出现手术相关并发症。两组患者术后1个月VAS和ODI评分无明显统计学差异(P>0.05)。结论在经皮椎间孔镜手术中,硬膜外舒芬太尼复合低浓度罗哌卡因,与单纯罗哌卡因相比能减少静脉镇痛药物用量。Objective To compare the anesthetic effects of different epidural anesthetic regimens in percutaneous transforaminal endoscopic discectomy. Methods 40 patients with lumbar disc herniation undergoing percutaneous transforaminal endoscopic discectomy were randomly divided into 2 groups （20 cases in each group）： group A was given 10 ml of epidural 0.25% ropivacaine, group B was given 5 pog of Sufentanil and 10 ml of 0.25% ropivacaine epidurally. The blood pressure, heart rate and VAS score of the two groups were recorded before surgery（T0）, at the time of skin incision （T1）, channel dilation （T2）, nerve roots stimulation （T3）, removal of nucleus pulposus （T4） and at the end of surgery（T5）. The VAS score, patient satisfaction and operation-related complications at 1 month after operation were also recorded. Satisfaction of postoperative curative effect was assessed using Oswestry Disability Index. Results The MAP and HR at T3 and T4 of group B were significantly lower than group A（P〈0.05）. The sufentanil dosage and intraoperative VAS scores of group B were significantly lower than group A（P〈0.05）. No operation-related complications occurred in either group. There was no significant difference in VAS and ODI scores between two groups 1 month after operation （P〉0.05）. Conclusion Compared with ropivacaine alone, epidural sufentanil combined with low concentration of ropivacaine reduced the dosage of intravenous analgesics in percutaneous transforaminal endoscopic discectomy.

关 键 词：硬膜外 舒芬太尼 椎间孔镜手术 低浓度罗哌卡因 

分 类 号：R614[医药卫生—麻醉学]