超声引导双侧竖脊肌平面阻滞复合全麻在胸腰椎单节段退行性疾病后入路矫治术中的应用  

Application of Ultrasound-Guided Bilateral Erector Spinae Plane Block Combined with General Anesthesia in Posterior Approach Correction of Single Segment Degenerative Disease of Thoracolumbar Spine

作　　者：慕迪迪 张运淳[2] 蔡宁[3] 潘鑫 MU DI-di;ZHANG Yun-chun;CAI Ning;PAN Xin(Bengbu Medical College,Bengbu 233003,Anhui,China;the First Affiliated Hospital of Bengbu Medical College,Bengbu 233003,Anhui,China;Fuyang People's Hospital,Fuyang 236006,Anhui,China)

机构地区：[1]蚌埠医学院,安徽蚌埠233003 [2]蚌埠医学院第一附属医院,安徽蚌埠233003 [3]阜阳市人民医院,安徽阜阳236006

出　　处：《中国现代手术学杂志》2021年第4期298-303,共6页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨超声引导双侧竖脊肌平面阻滞复合全身麻醉在胸腰椎单节段退行性疾病后入路矫治术中的应用效果。方法选取2020年1月~2020年10月本院收治的100例拟行后入路矫治术的胸腰椎单节段退行性疾病患者,随机分为甲乙两组,每组各50例。甲组实施单纯全麻,乙组实施超声引导双侧竖脊肌平面阻滞复合全麻。比较麻醉开始前5 min(T_(0))、麻醉后10 min(T_(1))、手术开始后10 min(T_(2))、术毕时(T_(3))、术后2 h(T_(4))的心率(heart rate,HR)、平均动脉压(mean artery pressure,MAP)变化情况,并比较术中药物用量、术后气管拔管时间、术后苏醒时间及术后2 h、6 h、12 h、24 h、48 h的疼痛视觉模拟评分(visual analogue scale,VAS),另比较术后镇痛泵按压次数、补救性镇痛率及不良反应发生率。结果HR、MAP在组间、时间、交互方面比较差异有统计学意义(P<0.05),除T_(0)与T_(1)、T_(2)、T_(3)、T_(4)比较以及T_(1)与T_(2)比较外,甲组组内其余各时刻HR、MAP两两比较差异均无统计学意义(P>0.05);除T_(2)与T_(4)比较外,乙组组内其余各时刻HR、MAP两两比较差异均无统计学意义(P>0.05);甲组T_(1)、T_(2)、T_(3)、T_(4)时刻的HR、MAP高于乙组(P<0.05);乙组术中丙泊酚、瑞芬太尼、顺式阿曲库铵用量均少于甲组(P<0.05),乙组术后气管拔管时间、苏醒时间与甲组比较差异无统计学意义(P>0.05);术后静息状态下VAS评分在组间、时间、交互方面差异有统计学意义(P<0.05),甲组术后48h的静息VAS评分低于术后6 h、12 h、24 h(P<0.05),乙组术后48 h的静息VAS评分低于术后24 h(P<0.05),乙组术后2 h、6 h、12 h、24 h、48 h的静息VAS评分均低于甲组(P<0.05);乙组术后镇痛泵按压次数少于甲组(P<0.05),使用曲马多补救镇痛率低于甲组(P<0.05);两组不良反应发生率比较差异无统计学意义(P>0.05)。结论在胸腰椎单节段退行性疾病后入路矫治术中应用超声引导双侧竖脊肌�Objective To investigate the effect of ultrasound-guided bilateral erector spinae plane block combined with general anesthesia in posterior approach correction of single segment degenerative disease of thoracolumbar spine.Methods 100 patients with single segment degenerative disease of thoracolumbar spine undergoing posterior approach correction admitted in our hospital from January 2020 to October 2020 were selected,who were randomly divided into group A and group B,with 50 cases in each.Group A received simple general anesthesia,while group B received ultrasound-guided bilateral erector spinae plane block combined with general anesthesia.The changes of heart rate(HR)and mean arterial pressure(MAP)at 5min before anesthesia(T_(0)),10min after anesthesia(T_(1)),10min after operation(T_(2)),at the end of operation(T_(3))and 2h after operation(T_(4))were compared,and the intraoperative drug dosage,postoperative tracheal extubation time,postoperative recovery time and visual analogue scale(VAS)at 2h,6h,12h,24h and 48h after operation were also compared,then the pressing times of analgesia pump,the situation of rescue analgesia and the occurrence of adverse reactions were compared.Results There were significant differences in HR and MAP over groups,time and interactions(P<0.05),but there were no significant differences in HR and MAP at other time points in group A except T_(0)vs.T_(1),T_(2),T_(3),T_(4)and T_(1)vs.T_(2)(P>0.05).There was no significant difference in HR and MAP at other time points in group B except T_(2)vs.T_(4)(P>0.05).The HR and MAP at T_(1),T_(2),T_(3)and T_(4)in group A were higher than those in group B(P<0.05).The intraoperative dosage of propofol,remifentanil and cisatracurium in group B were less than those in group A(P<0.05),but there was no significant difference in postoperative tracheal extubation time and recovery time between the two groups(P>0.05).There were significant differences in postoperative resting VAS over groups,time and interactions(P<0.05),and the resting VAS of group A at 48h

关 键 词：竖脊肌平面阻滞 全身麻醉 胸腰椎单节段退行性疾病 后入路矫治术 血流动力学 镇痛效果 

分 类 号：R687.3[医药卫生—骨科学]