胸腰筋膜平面阻滞对经皮椎间孔镜手术常规麻醉的优化效果  

Optimized effect of thoracolumbar interfascial plane block on routine anesthesia in patients undergoing transforaminal lumbar spine endoscopic surgery

作　　者：程传喜 舒爱华[1] 陈小波[1] 周密[1] 王强[1] Cheng Chuanxi;Shu Aihua;Chen Xiaobo;Zhou Mi;Wang Qiang(Department of Anesthesiology,The People′s Hospital of China Three Gorges University The First People′s Hospital of Yichang Institute of Geriatric Anesthesiology,Three Gorges University,Yichang 443000,China)

机构地区：[1]三峡大学人民医院宜昌市第一人民医院麻醉科三峡大学老年麻醉医学研究所,443000

出　　处：《中华麻醉学杂志》2019年第12期1492-1495,共4页Chinese Journal of Anesthesiology

摘　　要：目的评价胸腰筋膜平面(TLIP)阻滞对经皮椎间孔镜手术常规麻醉的优化效果。方法择期行单节段经皮腰椎椎间孔镜手术患者72例,ASA分级Ⅰ-Ⅲ级,性别不限,年龄45~75岁,BMI 18~25 kg/m^2,采用随机数表法分为3组(n=24):对照组(C组)、内侧入路TLIP阻滞组(M组)和外侧入路TLIP阻滞组(L组)。M组由外侧向内侧进针,在术侧L3平面多裂肌与胸最长肌之间的胸腰筋膜内注入0.375%罗哌卡因20 ml,L组由内侧向外侧进针,在术侧L3平面胸最长肌与髂肋肌之间的胸腰筋膜内注入0.375%罗哌卡因20 ml。采用0.375%罗哌卡因行皮肤、皮下、深筋膜、关节突周围逐层浸润。术中静脉输注右美托咪定0.5μg·kg^-1·h^-1和瑞芬太尼0.05~0.10μg·kg^-1·min^-1,维持Ramsay镇静评分2-3分,VAS评分<4分。记录术中右美托咪定、瑞芬太尼及罗哌卡因的用量;记录术中心血管事件、呼吸抑制、局麻药中毒和术后恶心呕吐等不良反应发生情况。结果与C组比较,M组和L组术中右美托咪定、瑞芬太尼、罗哌卡因用量和高血压发生率降低(P<0.05);与M组比较,L组术中右美托咪定、瑞芬太尼及罗哌卡因用量降低(P<0.05),不良反应发生率差异无统计学意义(P>0.05)。结论TLIP阻滞可优化经皮椎间孔镜手术常规麻醉的效果,且外侧入路TLIP阻滞的优化效果优于内侧入路。Objective To evaluate the optimized effect of thoracolumbar interfascial plane(TLIP)block on routine anesthesia in the patients undergoing transforaminal lumbar spine endoscopic surgery.Methods Seventy-two American Society of Anesthesiologists physical statusⅠ-Ⅲpatients of both sexes,aged 45-75 yr,with body mass index of 18-25 kg/m^2,undergoing elective single-segment transforaminal lumbar spine endoscopic surgery,were divided into 3 groups(n=24 each)using a random number table method:control group(group C),medial approach to TLIP group(group M),and lateral approach to TLIP group(group L).TLIP block was performed by advancing the block needle in a lateral to medial direction and injecting 0.375%ropivacaine 20 ml locally between the multifidus and longissimus muscles at the operation side of the third lumbar vertebra in group M.TLIP block was performed by advancing the block needle in a medial to lateral direction and injecting 0.375%ropivacaine 20 ml locally between the longissimus and iliocostalis muscles at the operation side of the third lumbar vertebra in group L.The skin,subcutaneous,deep fascia and surrounding of articular process were infiltrated with 0.375%ropivacaine layer by layer.Dexmedetomidine(0.5μg·kg^-1·h^-1)and remifentanil(0.05-0.10μg·kg^-1·min^-1)were intravenously infused to maintain Ramsay sedation score at 2-3 points and visual analog scale score<4 points during the operation.The intraoperative consumption of dexmedetomidine,remifentanil and ropivacaine were recorded.The intraoperative occurrence of cardiovascular events,respiratory depression,local anesthetic poisoning,and postoperative nausea and vomiting were recorded.Results Compared with group C,the intraoperative consumption of dexmedetomidine,remifentanil,ropivacaine and incidence of intraoperative hypertension were significantly decreased in M and L groups(P<0.05).Compared with group M,the intraoperative consumption of dexmedetomidine,remifentanil and ropivacaine were significantly decreased(P<0.05),and no significant change

关 键 词：神经传导阻滞 筋膜 椎间孔切开术 

分 类 号：R614[医药卫生—麻醉学]