多模式镇痛在局部麻醉经椎间孔入路经皮内窥镜下椎间盘切除术中的应用  

Application of multimodal analgesia in percutaneous endoscopic transforaminal discectomy under local analgesia

作　　者：李杰[1] 江伟[1] 彭立鹏 LI Jie;JIANG Wei;PENG Li-peng(Second Department of Orthopaedics,Second People’s Hospital of Yibin,Yibin 644000,Sichuan,China)

机构地区：[1]宜宾市第二人民医院骨二科,宜宾644000

出　　处：《脊柱外科杂志》2020年第6期392-397,共6页Journal of Spinal Surgery

摘　　要：目的探讨多模式镇痛在局部麻醉经椎间孔入路经皮内窥镜下椎间盘切除术(PETD)中的应用效果。方法回顾性分析2017年5—2019年5月在局部麻醉下采用PETD治疗的120例单节段腰椎椎间盘突出症(LDH)患者临床资料,按镇痛方式分组,对照组(60例)术中采用穿刺部位常规局部浸润麻醉,观察组(60例)在对照组基础上采用帕瑞昔布钠联合右美托咪定的多模式镇痛方案。比较2组患者术前(T0)、手术开始时(T1)、椎间孔成形期(T2)、纤维环操作期(T3)、手术结束时(T4)及术后2 h(T5)的心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO2)、疼痛视觉模拟量表(VAS)评分、Ramsay镇静评分;检测术中白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)水平;记录术中不良反应发生率。采用腰腿痛VAS评分,Oswestry功能障碍指数(ODI)和改良MacNab标准评估手术疗效。结果T1、T2、T3、T4时间点,观察组HR、MAP低于对照组;T1、T2、T3、T4、T5时间点,观察组VAS评分低于对照组,Ramsay镇静评分高于对照组;差异均有统计学意义(P<0.05)。2组T4、T5时间点IL-6、TNF-α水平均高于T0时间点,观察组T4、T5时间点IL-6、TNF-α水平低于对照组,差异均有统计学意义(P<0.05)。发生术中不良反应观察组8例(13.33%),对照组19例(31.67%),组间差异有统计学意义(P<0.05)。2组术后各时间点VAS评分、ODI均低于术前,观察组术后1 d、3 d VAS评分及ODI低于对照组,差异均有统计学意义(P<0.05)。末次随访时改良MacNab疗效评定:观察组优33例,良22例,可4例,差1例,优良率为91.67%;对照组优32例,良21例,可7例,优良率为88.33%;组间差异无统计学意义(P>0.05)。结论对在局部麻醉下采用PETD治疗的LDH患者采用多模式镇痛方案,可维持患者术中血流动力学稳定,获得良好的镇静、镇痛效果,降低术中炎性因子水平及不良反应发生率,促进患者术后快速康复。Objective To explore the application effect of multimodal analgesia in percutaneous endoscopic transforaminal discectomy(PETD)under local anesthesia.Methods The clinical data of 120 patients with single-segment lumbar disc herniation(LDH)treated by PETD under local anesthesia from May 2017 to May 2019 were retrospectively analyzed.The patients were equally divided into 2 groups according to the analgesic methods,the control group received conventional local infiltration anesthesia at the puncture site during the operation,and the observation group received the multimodal analgesia with parecoxib sodium and dexmedetomidine on the basis of the control group.Heart rate(HR),mean arterial pressure(MAP),blood oxygen saturation(SpO2),visual analogue scale(VAS)score and Ramsay sedation score at pre-operation(T0),beginning of surgery(T1),stage of vertebral foramen formation(T2),stage of annulus fibrosus operation(T3),end of surgery(T4)and postoperative 2 h(T5)were compared between the 2 groups.Intraoperative levels of interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)were detected.The incidence of intraoperative adverse reactions was recorded.The low back and leg pain VAS score,Oswestry dysfunction index(ODI)and the modified MacNab criteria were used to evaluate the efficacy of the surgery.Results At T1,T2,T3 and T4,HR and MAP were lower in the observation group than in the control group;at T1,T2,T3,T4 and T5,VAS scores were lower in the observation group than in the control group,Ramsay sedation scores were higher in the observation group than in the control group;and the differences were all statistically significant(P<0.05).The levels of IL-6 and TNF-αin the 2 groups were higher at T4,T5 than at T0,and the levels of IL-6 and TNF-αat T4,T5 were lower in the observation group than in the control group,all with significant differences(P<0.05).There were 8 cases(13.33%)of intraoperative adverse reactions in the observation group and 19(31.67%)in the control group,and the difference between the 2 groups was statistic

关 键 词：腰椎 内窥镜检查 椎间盘切除术 经皮 外科手术 微创性 麻醉 局部 镇痛 

分 类 号：R681.553.1[医药卫生—骨科学]