对采用不同麻醉方式经椎间孔入路内镜治疗腰椎间盘突出症的疗效分析  

Clinical efficacy of endoscopic treatment of lumbar intervertebral disc herniation by transforaminal approach under different anesthesia methods

作　　者：郑筱亭 蒋继乐[1] 安岩[1] 韦祎[1] 韩晓光[1] 何达[1] 刘波[1] Zheng Xiaoting;Jiang Jile;An Yan;Wei Yi;Han Xiaoguang;He Da;Liu Bo(Department of Spine Surgery,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院脊柱外科,100035 [2]福建省泉州市华侨大学附属德化医院骨科,362021

出　　处：《骨科临床与研究杂志》2022年第6期356-361,共6页Journal Of Clinical Orthopedics And Research

基　　金：首都卫生发展科研专项基金(2020-4-2076);积水潭学科骨干基金(XKGG20814)。

摘　　要：目的探讨全身麻醉与局部麻醉方式经椎间孔入路椎间孔镜治疗腰椎间盘突出症的临床疗效。方法2018年4月至2021年4月因L4/5节段腰椎间盘突出症在北京积水潭医院脊柱外科接受椎间孔入路椎间孔镜手术治疗的患者513例。根据麻醉方式的不同分为A、B两组。其中A组选择全身麻醉手术;B组选择局部麻醉手术。记录手术时间、术中出血量、住院时间、住院总费用、术前和术后1年Oswestry功能障碍指数(ODI)和疼痛视觉模拟评分(VAS)、术后1年改良MacNab评分、Likert五分量表法评价、再手术意愿情况。结果两组患者手术均顺利完成,术中无血管、神经损伤等严重并发症。两组患者年龄、性别、手术时间、住院时间差异无统计学意义。全麻组住院总费用多于局麻组(P=0.000)。两组术中出血量差异无统计学意义。再手术意愿全麻组明显多于局麻组(P=0.038)。全麻组手术体验Likert五分量表结果显著优于局麻组(P=0.007)。两组术后1年随访改良MacNab标准评价患者临床疗效,满意率高,差异无统计学意义。两组术后ODI评分及VAS评分比较较术前明显降低(P<0.05),但两组之间比较差异无统计学意义。结论全身麻醉具有良好的手术体验、术中血流动力学稳定等优点,但是也会增加手术费用。局麻手术具有费用低、恢复快等优势,但术中疼痛控制不佳。由于,每种麻醉方式都有自身的优势与不足,但两种麻醉方式下的椎间孔镜手术都能够安全进行,术者应个体化选择适合病人的麻醉方式。Objective To investigate the clinical effect of endoscopy for the treatment of lumbar disc herniation by general anesthesia or local anesthesia.Methods From April 2018 to December 2021,513 patients underwent foraminal approach of endoscopy for L4/5 lumbar disc herniation in Beijing Jishuitan Hospital.Group A and Group B were divided according to different anesthesia methods.General anesthesia was used in group A and local anesthesia was used in group B.Collect relevant index included operative time,intraoperative blood loss,hospital stay time,total hospitalization cost,evaluation of patient satisfaction before and 1 year after surgery(ODI and VAS scores),and modified MacNab criteria 1 year after surgery.Likert five-scale method was used to evaluate the patients'experience of surgery.The willingness to reoperate was investigated on the first day after surgery.Results The operation was successfully completed in both groups,without serious complications such as vascular and nerve injury.There were no significant differences in age and gender between the two groups.Operation time and hospital stay were longer in general anesthesia group than in local anesthesia group,but the differences were not statistically significant.Total hospitalization cost of general anesthesia group was higher than that of local anesthesia group,and the difference was statistically significant(P=0.000).There was no significant difference in intraoperative blood loss between the two groups.The willingness of reoperation in general anesthesia group was significantly higher than that in local anesthesia group,and the difference was statistically significant(P=0.038).The Likert 5-point scale of surgical experience in general anesthesia group was significantly better than that in local anesthesia group,with statistical difference(P=0.007).The two groups were followed up 1 year after operation to evaluate the clinical efficacy of patients with modified MacNab criteria,and the satisfactory rate was high,and there was no statistical difference betwe

关 键 词：椎间盘移位 腰椎 麻醉 全身 麻醉 局部 内窥镜检查 

分 类 号：R614[医药卫生—麻醉学]