骨质疏松性椎体压缩骨折经皮椎体后凸成形术中应用不同麻醉方式对疼痛阈值的影响  

Effects of Different Anesthesia Methods on Pain Thresholds Guring Percutaneous Kyphoplasty for Osteoporotic Vertebral Compression Fractures

作　　者：张浩 蔡永林 李帆 刘春霞[4] 韩柳[4] ZHANG Hao;CAI Yong-lin;LI Fan;LIU Chun-xia;HAN Liu(Department of Surgical Anesthesia,Beijing Changping Hospital of Integrated Chinese and Western Medicine,Beijing,102208,China;Department Orthopedics 1,Beijing Changping Hospital of Integrated Chinese and Western Medicine,Beijing,102208,China;Department Anesthesiology,Children’s Hospital affiliated Capital Institute of Pediatrics,Beijing,100020,China;Department of Surgical Anesthesia,China-japan Friendship Hospital,Beijing,100029,China)

机构地区：[1]北京市昌平区中西医结合医院手术麻醉科,北京102208 [2]北京市昌平区中西医结合医院骨一科,北京102208 [3]首都儿童研究所附属儿童医院麻醉科,北京100020 [4]中日友好医院麻醉科,北京100029

出　　处：《现代生物医学进展》2022年第12期2322-2327,共6页Progress in Modern Biomedicine

基　　金：国家卫生计生委医药卫生科技发展项目(W2014ZT009)。

摘　　要：目的:探究骨质疏松性椎体压缩骨折经皮椎体后凸成形术中应用不同麻醉方式对疼痛阈值的影响。方法:选择120例接受经皮椎体后凸成形术治疗的骨质疏松性椎体压缩骨折患者,并将其随机分为全身麻醉组(n=40)、局部麻醉组(n=40)和硬膜外麻醉组(n=40)。对比分析三组麻醉效果、不同时间点疼痛阈值(VAS值)、疼痛总分(PRI)与疼痛强度(PPI)、温度疼痛阈值和电疼痛阈值以及采取自控镇痛、止痛药的情况。结果:全身麻醉组患者麻醉优良率为95.00%,局部麻醉组患者麻醉优良率为87.50%,硬膜外麻醉组患者麻醉优良率为92.50%。三组患者麻醉效果比较,全身麻醉组显著优于局部麻醉组和硬膜外麻醉组(P<0.05)。随着麻醉时间的延长,硬膜外麻醉组患者在麻醉后的VAS值、PRI和PPI值、温度疼痛阈值和电疼痛阈值均显著低于全身麻醉组和局部麻醉组患者(P<0.05)。全身麻醉组采取其他方式进行止痛的概率为1.67%,局部麻醉组为30.00%,硬膜外麻醉组为2.50%,差异有统计学意义(P<0.05)。结论:硬膜外麻醉方式对骨质疏松性椎体压缩骨折经皮椎体后凸成形术的麻醉效果和镇痛效果较全身麻醉和局部麻醉效果好,值得临床推广使用。Objective:To investigate the effect of different anesthesia methods on pain threshold during percutaneous kyphoplasty for osteoporotic vertebral compression fractures.Methods:120 patients with osteoporotic vertebral compression fractures who received percutaneous kyphoplasty were randomly divided into general anesthesia group(n=40),local anesthesia group(n=40)and epidural anesthesia group(n=40).The anesthesia effect,pain threshold at different time points,total pain score and pain intensity,temperature pain threshold and electric pain threshold,as well as the situation of self-controlled analgesia and analgesic were compared and analyzed in the three groups.Results:Excellent anesthesia rate was 95.00%in general anesthesia group,87.50%in local anesthesia group and92.50%in epidural anesthesia group.Comparison of anesthesia effect among three groups showed that general anesthesia group was significantly better than local anesthesia group and epidural anesthesia group(P<0.05).With the prolongation of anesthesia time,the VAS value,PRI and PPI value,temperature pain threshold and electric pain threshold of patients in epidural anesthesia group were significantly lower than those in general anesthesia group and local anesthesia group(P<0.05).In addition,the probability of taking other methods for pain relief in general anesthesia group was 1.67%,local anesthesia group was 30.00%,and epidural anesthesia group was 2.50%,the difference was statistically significant(P<0.05).Conclusion:The effect of epidural anesthesia on percutaneous kyphoplasty for osteoporotic vertebral compression fracture is better than that of general anesthesia and local anesthesia,which is worthy of clinical application.

关 键 词：骨质疏松性椎体压缩骨折 经皮椎体后凸成形术 疼痛阈值 硬膜外麻醉 全身麻醉 局部麻醉 

分 类 号：R683.2[医药卫生—骨科学] R687[医药卫生—外科学]