胸腰筋膜平面阻滞对多节段腰椎融合术病人的镇痛效果观察  

The effects of ultrasound-guided thoracolumbar interfascial plane block for postoperative analgesia in multi-level lumbar spine fusion surgery

作　　者：张胜男[1] 王洁 李红伟 徐进[1] ZHANG Shengnan;WANG Jie;LI Hongwei;XU Jin(Anesthesia Department of Tianjin Hospital,Tianjin 300211,China)

机构地区：[1]天津市天津医院麻醉科,天津300211

出　　处：《中国疼痛医学杂志》2021年第9期676-681,共6页Chinese Journal of Pain Medicine

基　　金：天津市卫生健康委员会科技项目(ZC20068)。

摘　　要：目的:观察超声引导下双侧胸腰筋膜平面(thoracolumbar interfascial plane,TLIP)阻滞对多节段腰椎融合术病人的镇痛效果。方法:选择天津医院2019年5月至2020年12月因腰椎间盘突出就诊于脊柱科并行多节段腰椎融合术的病人40例,按随机数字表法随机分为两组(每组20例):对照组(C组)进行常规全身麻醉手术,阻滞组(TP组)在全身麻醉之前,在超声引导下行双侧胸腰筋膜阻滞,药物为0.4%的罗哌卡因各20 ml。比较两组术中丙泊酚、瑞芬太尼和舒芬太尼用量及苏醒期躁动的发生率,观察两组病人术后1 h、6 h、12 h、24 h、48 h的静息疼痛视觉模拟评分法(visual analogue scale,VAS)评分和咳嗽VAS评分,以及术后自控镇痛次数和补救镇痛次数,并观察两组术后的不良反应(包括恶心呕吐、呼吸抑制、头晕、瘙痒等)发生率。结果:与对照组相比,阻滞组病人术中丙泊酚及瑞芬太尼的用量明显减少,舒芬太尼用量无明显差异,且苏醒期躁动发生率明显降低(P<0.05)。与对照组相比,阻滞组病人术后1 h、6 h、12 h、24 h、48 h的静息和咳嗽VAS评分均明显降低,差异有统计学意义(P<0.05),但阻滞组病人术后24 h静息VAS和咳嗽VAS评分与术后1 h、6 h、12 h相比有明显的升高,而在术后48 h与24 h相比明显下降。与对照组相比,阻滞组病人术后12 h、24 h、48 h自控镇痛次数及补救镇痛次数明显降低,且恶心呕吐发生率明显降低(P<0.05),两组病人呼吸抑制、头晕、瘙痒等发生情况差异无统计学意义。结论:超声引导下双侧胸腰筋膜阻滞可以有效减轻围术期病人的疼痛程度,减少全身麻醉药的使用,降低阿片类药物引起的副作用,且无明显不良反应,值得临床推广。Objective:To observe the effects of ultrasound-guided bilateral thoracolumbar interfascial plane(TLIP)for postoperative analgesia in multi-level lumbar spine fusion surgery.Methods:A total of 40 patients with Lumbar disc herniation for multi-level lumbar spine fusion surgery were randomly divided into the TLIP group(group TP)and control group(group C)(n=20 each)from May,2019 to Dec,2020 in Tianjin Hospital.The group C received general anesthesia only.The group TP received ultrasound-guided bilateral thoracolumbar interfascial plane with 20 ml 0.4%ropivacaine before general anesthesia.The consumption of propofol,remifetanil and sufentanil and the incidence of emergence delirium after operation were recorded.The resting/coughing VAS score at 1 h,6 h,12 h,24 h,48 h postoperatively,the number of PCA compressions and rescue analgesic administrations were compared between the two groups.Adverse reactions(nausea and vomiting,respiratory depression,dizziness and pruritus)were recorded.Results:Compared with the group C,the consumption of propofol and remifetanil and the incidence of emergence delirium after operation decreased in the group TP(P<0.05),but there was no difference in the consumption of sufentanil between the two groups.Compared with the group C,the resting/coughing VAS score at 1 h,6 h,12 h,24 h,48 h postoperatively were significantly lower in the group TP(P<0.05),but the VAS scores increased significantly at 24 h postoperatively compared with 1 h,6 h,12 h after operation and decreased at 48 h in the group TP.Compared with the group C,the number of PCA compressions,the number of rescue analgesic administrations and the occurrence of adverse reactions were decreased in the group TP,but there were no differences in the incidence of respiratory depression,dizziness or pruritus.Conclusion:Ultrasound-guided bilateral thoracolumbar interfascial plane block not only can reduce the pain degree and perioperative anesthetics consumption,but also decline the incidence of nausea and vomiting in patients undergoing poste

关 键 词：胸腰筋膜平面阻滞 腰椎融合术 镇痛 

分 类 号：R614[医药卫生—麻醉学]