超声引导下改良胸腰筋膜间隙平面阻滞在后路腰椎减压融合术的临床研究  

Ultrasound-guided modified thoracolumbar interfascial plane block in posterior lumbar decompression and fusion

作　　者：胡立 肖旺频[2] 郁丽娜 周红梅[2] 张才军 谢俊然[1] Hu Li;Xiao Wangpin;Yu Lina;Zhou Hongmei;Zhang Caijun;Xie Junran(Department of Anesthesiology,Sir Runrun Shaw Hospital Affiliated to Zhejiang University,Hangzhou 310016,China;Department of Anesthesiology,the Second Affiliated Hospital,Jiaxing University,Jiaxing 314000,China;Department of Anesthesiology,the Second Affiliated Hospital of Zhejiang University,Hangzhou 310009,China)

机构地区：[1]浙江大学附属邵逸夫医院麻醉科,杭州310016 [2]嘉兴学院附属第二医院麻醉科,314000 [3]浙江大学附属第二医院麻醉科,杭州310009

出　　处：《中华实验外科杂志》2020年第7期1342-1344,共3页Chinese Journal of Experimental Surgery

摘　　要：目的探讨超声引导下改良胸腰筋膜间隙平面(TLIP)阻滞的便捷性、有效性、安全性。方法选取嘉兴市第二医院全麻下后路腰椎减压融合手术患者60例,采用随机数字法分为两组(n=30):超声引导下改良TLIP阻滞组(A组)、超声引导下TLIP阻滞组(B组)。A组在第3腰椎水平线两侧最长肌和髂肋肌之间的胸腰筋膜各注射0.375%罗哌卡因20 ml,B组在第3腰椎水平线两侧多裂肌和最长肌之间的胸腰筋膜各注射0.375%罗哌卡因20 ml。记录神经阻滞操作时间、穿刺次数、阻滞20 min后以温度觉测定阻滞范围、满意度评分。两组术后均行静脉自控止痛泵(PCIA),静态视觉模拟评分法(VAS)评分>4分,静注帕瑞昔布40 mg补救并记录。记录患者术后神经阻滞相关并发症,术后不良反应。采用t检验,计数资料采用χ2检验。结果与B组比较,A组操作时间[(10.3±2.3) min比(16.7±3.2) min]更短、穿刺次数[(2.4±0.6)次比(3.5±1.0)次]更少、满意度评分[(3.4±0.5)分比(2.8±0.7)分]更高,差异有统计学意义(t=-11.494、-6.086、3.850,P<0.05),A组和B组阻滞面积[(282.9±61.1) cm2比(279.5±62.8) cm2],差异无统计学意义(t=0.168,P>0.05)。A组和B组PCIA有效按压次数[(5.55±1.27)次比(5.17±2.09)次]、PCIA药物用量[(59.10±2.54) μg比(58.34±4.18) μg]、帕瑞昔布补救量比[(52.4±35.6) mg比(51.0±42.6) mg]比较,差异无统计学意义(t=0.737、0.737、0.118,P>0.05)。A组和B组均无神经阻滞相关并发症,术后并发症(恶心呕吐、呼吸抑制、低血压)比较,差异无统计学意义(χ2=0.126、1.052、0.983,P>0.05)。结论超声引导下改良TLIP阻滞操作更加便捷快速,患者满意度更高;超声引导下改良TLIP阻滞和TLIP阻滞的阻滞效果无明显差异,均可有效用于腰椎后路手术术后镇痛。Objective:To evaluate the convenience,effectiveness and safety of the ultrasound-guided modified thoracolumbar interfascial plane(TLIP)block.Methods:Sixty patients who underwent posterior lumbar decompression and fusion under general anesthesia were selected,and randomly divided into two groups(n=30):ultrasound-guided modified TLIP block group(group A),ultrasound-guided TLIP block group(group B).In group A,0.375%ropivacaine(20 ml)was injected into the thoracolumbar interfascia between the bilateral longissimus and iliocostalis muscles on both sides of the third lumbar horizontal line.In group B,0.375%ropivacaine(20 ml)was injected into the thoracolumbar interfascia between the bilateral multifidus and longissimus muscles on both sides of the third lumbar horizontal line.The operation time and puncture times of nerve block were recorded.After 20 min of block,the block range was measured by temperature sensation,and the satisfaction score of puncture was taken.Patient controlled intravenous analgesia(PCIA)was used in both groups after operation.When visual analogue scale(VAS)score at rest>4 after surgery,the patients were given piraxib 40 mg for remedy,and the amount of remedy drug was recorded.The complications related to nerve block and adverse reactions were recorded.Results:There was a shorter operation time[(10.3±2.3)min vs.(16.7±3.2)min],fewer punctures[(2.4±0.6)vs.(3.5±1.0)]and higher satisfaction score[(3.4±0.5)vs.(2.8±0.7)]in group A than in group B(t=-11.494,-6.086,3.850,P<0.05).However,there was no significant difference in block range[(282.9±61.1)cm 2 vs.(279.5±62.8)cm 2]between two groups.There were no significant differences in PCIA effective pressing times[(5.55±1.27)vs.(5.17±2.09)],PCIA drug dosage[(59.10±2.54)μg vs.(58.34±4.18)μg],parecoxib remedy amount[(52.4±35.6)mg vs.(51.0±42.6)mg]between two groups(t=0.737,0.737,0.118,P>0.05).There were no complications related to nerve block in group A and group B,and there were no significant differences in postoperative complications(nausea

关 键 词：超声引导 改良胸腰筋膜间隙平面阻滞 后路腰椎减压融合手术 术后镇痛 

分 类 号：R614[医药卫生—麻醉学]