不同麻醉方式对椎间孔镜手术的效果观察  

作　　者：傅之梅[1] 胡兵伟 马婷婷[1] 王宏伟 

机构地区：[1]浙江省立同德医院,310012

出　　处：《浙江临床医学》2022年第9期1385-1387,共3页Zhejiang Clinical Medical Journal

摘　　要：目的比较椎间孔镜手术(PELD)中不同麻醉方式对术中循环的影响及补救镇痛和避免神经损伤的优劣.方法筛选2017年10月至2020年1月择期实施的153例椎间孔手术,根据麻醉方式不同分为局部麻醉组(LA组)、0.4%罗哌卡因硬脊膜外麻醉组(EA组)和静脉麻醉组(IVA).比较3组术中血压(MAP)、心率(HR)的变化,补救镇痛和神经根无触觉的发生率.结果LA组术中MAP、HR峰值比EA组和IVA高,而EA组和IVA组比较差异无统计学意义;EA组术中高血压发生率、术中补救镇痛发生率比LA组低,EA组神经无触觉的发生率仅为2.4%.结论0.4%罗哌卡因硬脊膜外麻醉是PELD较优的麻醉方式,神经无触觉的发生率较低,镇痛完善、术中循环更平稳.Objective To compare the efcte of diferent anesthesia methods on intraoperative circulation,as well as the advantages and disadvantages of remedial analgesia and avoidance of nerve injury in intervertebral foraminal endoscopic surgery(PELD).Methods A total of 153 cases of iterertbral foramen surgery were seleted from October 2017 to January 2020,and they were divided into local anesthesia group(LA group),0.4%ropivacaine epidural anesthesia group(EA group)and intravenous anesthesia group(IVA)according to different anesthesia methods.The changes of intraoperative blood pressure(MAP),heart rate(HR),rescue analgesia and the incidence of nerve non tactile were compared among the three groups.Results The peak valucs of MAP and HR in local anestheia group(LA group)were higher than those in 0.4%ropivacaine epidural anestheia group(EA group)and intavenous anesthesia groupl(IVA group),but there was no significant diference between EA group and IVA group.The incidence of intraoperative hypertension and intraoperative remedial analgesia in EA group was lower than that in LA group,and the incidence of nerve non tactile in 0.4%ropivacaine epidural anesthesia was only 2.4%.Conclusion The 0.4%ropivacaine epidurl anesthesia is a better one for PELD.It not only have a low incidence of the nervous tactile loss,but also have adequate analgesia and stable intraoperative circulation.

关 键 词：硬脊膜外麻醉 罗哌卡因 经皮椎间孔镜下髓核摘除术 神经损伤 

分 类 号：R614[医药卫生—麻醉学]