超声引导下椎板后阻滞应用于经皮椎间孔镜手术的效果  

Anesthetic effect of ultrasound-guided retrolaminar block during percutaneous transforaminal lumbar spine endoscopic surgery

作　　者：刘庆波 王春姝 郑少华[1] 肖颖[1] 温健[1] 杜恒[2] LIU Qingbo;WANG Chunshu;ZHENG Shaohua;XIAO Ying;WEN Jian;DU Heng(Department of Anesthesiology,The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China;Department of Orthopedics,The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China)

机构地区：[1]西安交通大学第一附属医院麻醉手术部,陕西西安710061 [2]西安交通大学第一附属医院骨科,陕西西安710061

出　　处：《西安交通大学学报（医学版）》2022年第1期117-121,共5页Journal of Xi’an Jiaotong University（Medical Sciences）

基　　金：国家自然科学基金资助项目(No.81801388);陕西省自然科学基础研究计划(No.2020JM-388);西安交通大学第一附属医院临床研究项目(No.XJTU1AFCRC2019SJ-021)。

摘　　要：目的比较超声引导下椎板后阻滞(retrolaminar block,RLB)与局部浸润麻醉在经皮椎间孔镜腰椎间盘切除术(percutaneous endoscopic lumbar discectomy,PELD)中的麻醉效果。方法40例美国麻醉医师协会(ASA)Ⅰ或Ⅱ级择期行PELD手术的患者,随机分为超声引导下椎板后阻滞组(RLB组)和局部浸润麻醉组(C组),每组20例。RLB组由麻醉医师在超声引导下在脊柱旁矢状位平面内行椎板后阻滞,C组由手术医师根据手术定位逐层局部浸润麻醉,所用药物均为0.5%罗哌卡因20 mL。记录入室(T_(0))、切皮(T_(1))、穿刺时(T_(2))、椎间孔成形(T_(3))、神经减压(T_(4))、缝合时(T_(5))VAS评分和Ramsay镇静评分,记录补救镇痛率和患者满意度,以及术中呼吸抑制、心动过速、高血压等不良反应的发生率,记录术前及术后3个月的Oswestry功能障碍指数(ODI)评分。结果RLB组T_(2-4)时点VAS评分和补救镇痛率显著低于C组(P<0.05),RLB组患者满意度显著高于C组(P<0.05),术中高血压和心动过速的发生率显著低于C组(P<0.05),两组患者术后3个月ODI评分明显低于术前(P<0.05),但组间ODI评分差异无统计学意义(P>0.05)。结论超声引导下椎板后阻滞(RLB)能够为PELD手术提供满意的镇痛效果,不影响下肢运动功能,不良反应少,安全性高。Objective To compare the anesthestic effects of ultrasound-guided retrolaminal block(RLB)and local anesthesia during posterior approach vertebral surgery.Methods Forty patients(ASA physical status Ⅰ or Ⅱ)scheduled for transforaminal lumbar spine endoscopic surgery were recruited and randomly divided into two groups(n=20):RLB group and local anesthesia group(Group C).RLB group received the ultrasound-guided retrolaminar block using parasagittal in plane method by an anesthesiologist while Group C received layer-by-layer local infiltration anesthesia according to the operation location;0.5% ropivacaine of 20 mL was used in the two groups.We recorded visual analogue score(VAS)and Ramsay sedation score at admission(T_(0)),during skin incision(T_(1)),puncture(T_(2)),foraminoplasty(T_(3)),nerve root decompression(T_(4))and suture(T_(5)).We also recorded remedial analgesia rate,scores of the patients’satisfaction and the intraoperative occurrence of side effects(respiratory depression,tachycardia and hypertension).The patients were followed up.Their functional status was assessed by the Oswestry Disability Index(ODI)score before surgery and three months after surgery.Results Compared with Group C,RLB group had significantly decreased visual analogue score at T_(2-4) and lower remedial analgesia rate(P<0.05).The patients’satisfaction was higher in group RLB than in Group C(P<0.05).The intraoperative occurrence of hypertension and tachycardia were significantly lower in RLB group than in Group C(P<0.05).ODI score was significantly decreased three months after surgery in both groups(P<0.05),but it did not differ significantly between the two groups(P>0.05).Conclusion Ultrasound-guided RLB can provide satisfactory analgesia with greater safety when trasforaminal endoscopic surgery is used.

关 键 词：超声引导 椎板后阻滞 经皮椎间孔镜腰椎间盘切除术 

分 类 号：R614.4[医药卫生—麻醉学]