超声引导下颈浅丛神经阻滞对颈椎前路减压融合术患者术后早期康复质量的影响  

Effect of ultrasound-guided superficial cervical plexus block on early postoperative quality of recovery after anterior cervical discectomy and fusion

作　　者：汪树东 韩明明 王松[1] 康芳 王胜[1] 李娟[1] WANG Shudong;HAN Mingming;WANG Song;KANG Fang;WANG Sheng;LI Juan(Department of Anesthesiology,the First Affiliated Hospital of USTC,Division of Life Sciences and Medicine,University of Science and Technology of China,Hefei 230001,China)

机构地区：[1]中国科学技术大学附属第一医院(安徽省立医院)麻醉科,合肥市230001

出　　处：《临床麻醉学杂志》2020年第4期326-329,共4页Journal of Clinical Anesthesiology

基　　金：安徽省自然科学基金(1908085MH251)。

摘　　要：目的评价超声引导下颈浅丛神经阻滞对颈椎前路减压融合术患者术后早期康复质量的影响。方法择期行颈前路手术的颈椎病患者60例,男37例,女23例,年龄18~70岁,BMI 18.5~29.5 kg/m^2,ASAⅠ或Ⅱ级,采用随机数字表法分为两组:颈浅丛神经阻滞联合全麻组(S组)和全麻组(C组),每组30例。S组在全麻诱导前实施超声引导下右侧颈浅丛神经阻滞,注入0.375%罗哌卡因15 ml;C组不行神经阻滞。两组均静脉注射依托咪酯0.3 mg/kg、舒芬太尼0.4μg/kg、罗库溴铵0.6 mg/kg进行麻醉诱导,麻醉维持采用静-吸复合麻醉,术中维持BIS值40~60。分别于术前1 d、术后1 d采用QoR-40量表对患者进行评分。记录术中瑞芬太尼和丙泊酚用量、拔管时间、术后住院时间、术后补救镇痛情况,术后恶心呕吐、咽喉痛、吞咽困难、声音嘶哑等不良反应及神经阻滞相关并发症的发生情况。结果与C组比较,S组术后1 d的QoR-40总评分及身体舒适度、情绪状态、心理支持、疼痛评分明显提高(P<0.05),术中瑞芬太尼用量明显减少(P<0.05),术后补救镇痛率、术后恶心呕吐和吞咽困难发生率明显降低(P<0.05)。两组丙泊酚用量、拔管时间、术后住院时间、术后咽喉痛和声音嘶哑发生率差异无统计学意义。S组未出现神经阻滞相关并发症。结论超声引导下颈浅丛神经阻滞用于颈椎前路减压融合术,有利于提高患者早期康复质量。Objective To evaluate the effect of ultrasound-guided superficial cervical plexus block on early postoperative quality of recovery in patients after anterior cervical discectomy and fusion. Methods Sixty patients scheduled for elective anterior cervical discectomy and fusion, 37 males and 23 females, aged 18-70 years, with a BMI 18.5-29.5 kg/m^2, ASA physical status Ⅰ or Ⅱ, were randomly divided into 2 groups(n = 30 each): superficial cervical plexus block combined with general anesthesia group(group S) and general anesthesia group(group C). In group S, right side superficial cervical plexus block under ultrasound guidance was performed before anesthesia induction, and 0.375% ropivacaine 15 ml was injected. In group C, patients were anesthetized with general anesthesia only. Anesthesia was induced with IV etomidate, sufentanil and rocuronium in both groups. Anesthesia was maintained using intravenous-inhalation combined anesthesia. Bispectral index value was maintained at 40-60 during surgery. Patients were scored using the QoR-40 scale at 1 day before surgery and 1 day after surgery. The intraoperative requirement of remifentanil and propofol were recorded, extubation time and discharge time and postoperative requirement for rescue analgesia were recorded. The development of postoperative nausea and vomiting, sore throat, dysphagia, hoarseness and cervical plexus block-related adverse reactions were also recorded. Results Compared with group C, the global QoR-40 scores and the physical comfort score, the emotional state score, the psychological support score, the pain score were higher in group S at 1 day after surgery(P < 0.05). Compared with group C, the intraoperative need of remifentanil were significantly decreased(P < 0.05), the need for rescue analgesia and incidence of nausea and vomiting, dysphagia were significantly decreased(P < 0.05). There was no significant difference in propofol dosage, extubation time, postoperative hospital stay, and postoperative sore throat and hoarseness between the two g

关 键 词：颈浅丛神经阻滞 颈椎前路减压融合术 术后恢复质量 超声引导 

分 类 号：R614[医药卫生—麻醉学]