老年腰椎管狭窄症患者经皮脊柱内镜手术治疗时采用镇静镇痛术的麻醉经验  

Anesthetic experiences with sedation and analgesia technique during percutaneous endoscopic spinal surgery for the treatment of elderly patients with lumbar spinal stenosis

作　　者：荣雪芹 许静红[2] 郑庆玲[1] 赵利涛 林芳轲 刘洪升 邹海涛 Rong Xueqin;Xu Jinghong;Zheng Qingling;Zhao Litao;Lin Fangke;Liu Hongsheng;Zou Haitao(Department of Pain Spinal Minimally Invasive Center,Sanya Central Hospital(Hainan Third People's Hospital),Sanya City,Hainan Province 572000,China;Department of Anesthesia,Sanya Central Hospital(Hainan Third People's Hospital),Sanya City,Hainan Province 572000,China)

机构地区：[1]三亚中心医院(海南省第三人民医院)疼痛脊柱微创中心,三亚市572000 [2]三亚中心医院(海南省第三人民医院)麻醉科,三亚市572000

出　　处：《中华疼痛学杂志》2021年第4期386-391,共6页Chinese Journal Of Painology

基　　金：海南省卫生计生行业科研项目(20A200176)。

摘　　要：目的总结老年腰椎管狭窄症患者经皮脊柱内镜手术治疗时采用镇静镇痛术的麻醉经验。方法回顾性分析2018年1月至2019年7月三亚中心医院疼痛脊柱微创中心行经皮脊柱内镜手术的60岁及以上腰椎管狭窄患者212例,分析术前病情特征、手术相关情况和并发症、围术期疼痛管理、镇痛用药情况以及相关不良反应。手术中采用局部麻醉联合镇静镇痛术的麻醉方法。结果纳入患者平均年龄(72±7)岁。手术入路有椎间孔入路159例,椎板间入路53例。术后各时点腰腿痛评分均较术前显著减轻(P均<0.05)。术中腰腿部疼痛46例,高颅压性头痛14例,体位压迫性疼痛20例,其中腰腿部疼痛与腰椎管狭窄分级相关。术中疼痛管理相关不良反应为循环系统91例,消化系统36例,呼吸抑制3例,谵妄1例,其中血液动力学波动与ASA分级相关。术中局麻药1%利多卡因212例(36±4)ml;镇静药右美托咪定212例(115±41)μg;镇痛药物为纳布啡101例(15±4)mg,瑞芬太尼46例(0.080±0.020)μg·kg^(-1)·min^(-1),地佐辛41例(7±3)mg,氢吗啡酮37例(0.9±0.3)mg,舒芬太尼12例(11.0±1.2)μg,帕瑞昔布钠12例(40±0)mg。结论老年患者经皮脊柱内镜治疗腰椎管狭窄症手术时的疼痛管理采用局麻联合静脉镇静镇痛术的麻醉效果良好,但其用药需进一步规范。Objective To summarize the experiences of anesthetic management during percutaneous endoscopic spinal surgery in elderly patients with lumbar spinal stenosis.Methods A total of 212 patients,over 60-year-old underwent percutaneous endoscopic spinal surgery during January 2018 to July 2019 in Sanya Central Hospital,were retrospective analyzed in clinic features,condition of surgery and complications,perioperative pain,pain management,and drug applications.Local anesthesia combined with sedation and analgesic technique was adopted during the percutaneous endoscopic spinal surgery.Results The average age of the patients was(72±7)years old.There were 159 patients operated via intervertebral foramen,53 patients via lamina.The pain scores decreased significantly in lower back and leg at all time points after the operation than those before the operation(all P<0.05).There were 46 cases with lower back and leg pain during operation that were related with degree of lumbar stenosis,14 cases with intracranial hypertention headache,and 20 cases with position pressure pain.One case presented with paraesthesia after the operation.The complications related to intraoperative pain management occurred in circulatory system(91 cases),digestive system(36 cases),respiratory depression(3 cases),and delirium(1 case).There were 212,212,101,46,41,37,12 and 12 patients administered with 1%lidocaine(36±4)ml,dexmedetomidine(115±41)μg,nabufine(15±4)mg,remifentanil(0.080±0.020)μg·kg^(-1)·min^(-1),dezocine(7±3)mg,hydromorphone(0.9±0.3)mg,sufentanil(11.0±1.2)μg,and parecoxib sodium(40±0)mg,respectively.Conclusion The effects of pain management with sedation and analgesic technique during percutaneous endoscopic spinal surgery is better in the treatment of elderly patients with lumbar spinal stenosis,but further normalization of the medication is necessary.

关 键 词：老年人 腰椎管狭窄 经皮脊柱内镜手术 疼痛 不良反应 

分 类 号：R614[医药卫生—麻醉学]