超声引导竖脊肌平面双点阻滞和单点阻滞对腰椎手术镇痛的影响  

Effect of Ultrasound-guided Double Point Block and Single Point Block of Erector Spinalis Plane on Analgesia in Lumbar Surgery

作　　者：叶丽 夏瑞[1] YE Li;XIA Rui(The First Affiliated Hospital of Yangtze University,Jingzhou 434000,China;不详)

机构地区：[1]长江大学附属第一医院,湖北荆州434000

出　　处：《中国医学创新》2023年第2期5-11,共7页Medical Innovation of China

摘　　要：目的:探究超声引导竖脊肌平面双点阻滞与单点阻滞对腰椎手术后镇痛和快速康复的影响。方法:选择2021年10月-2022年3月于长江大学附属第一医院接受腰椎椎间融合术的90例患者为研究对象,随机分为三组,即双点组(n=30,接受超声引导竖脊肌平面双点阻滞+全身麻醉)、单点组(n=30,接受超声引导竖脊肌平面单点阻滞+全身麻醉)与对照组(n=30,仅接受全身麻醉)。术后三组患者均采用静脉自控镇痛泵,监测围手术期患者麻醉深度并维持麻醉深度Narcortrend指数(NI)位于D阶段,记录平均动脉压(MAP)、心率(HR),对比三组患者术中麻醉药物用量,记录术后48 h内数字评分量表(NRS)评分、追加镇痛及补救镇痛的次数,术后首次进食时间,术后首次排气时间;比较三组患者术后不良反应发生率;比较双点组与单点组起效时间、阻滞平面及阻滞操作时间的差异。结果:术中舒芬太尼与瑞芬太尼用量,双点组与单点组均显著低于对照组(P<0.05),但双点组与单点组比较,差异均无统计学意义(P>0.05);切皮后5 min时,双点组与单点组的MAP与HR均明显低于对照组(P<0.05),但双点组与单点组比较,差异均无统计学意义(P>0.05);单点组患者阻滞操作时间短于双点组,双点组阻滞平面高于单点组,起效时间早于单点组(P<0.05);离恢复室前5 min,双点组和单点组NRS评分均低于对照组(P<0.05),但双点组与单点组比较,差异无统计学意义(P>0.05);双点组和单点组术后48 h镇痛泵追加次数及补救镇痛次数均明显少于对照组,双点组与单点组患者术后首次排气时间和进食时间均短于对照组(P<0.05),但双点组与单点组上述指标比较,差异均无统计学意义(P>0.05);双点组和单点组在术后48 h内不良反应总发生率组间差异无统计学意义(P>0.05),三组不良反应总发生率比较,差异有统计学意义(P<0.05)。结论:相比于单纯全身麻醉,超声引导下竖脊肌平面双Objective: To explore the effect of ultrasound-guided double point block and single point block on postoperative analgesia and rapid rehabilitation of lumbar spine surgery. Method: Ninety patients who underwent lumbar interbody fusion in the First Affiliated Hospital of Yangtze University from October 2021 to March 2022were selected, they were randomly divided into three groups, double point group(n=30, receiving ultrasound-guided erector spinae plane double point block plus general anesthesia), single point group(n=30, receiving ultrasoundguided erector spinae plane single point block plus general anesthesia) and control group(n=30, only receiving general anesthesia). All patients in the three groups were treated with patient-controlled intravenous analgesia pump,the anesthesia depth of perioperative patients was monitored and maintained, Narcortrend index(NI) was at D stage.The mean arterial pressure(MAP) and heart rate(HR) were recorded. The amount of anesthetic drugs used in the three groups were compared, the score of number rating scale(NRS), the number of additional analgesia and relief analgesia were recorded within 48 h after surgery, the time of first eating after operation and the time of first exhaust after operation were recorded. The incidence of postoperative adverse reactions was compared among the three groups. The difference of onset time, block plane and block operation time between the double point group and the single point group was compared. Result: The dosage of sufentanil and remifentanil in the double point group and the single point group were significantly lower than those in the control group(P<0.05), but there were no differences between the double point group and single point group(P>0.05). At 5 min after skin incision, MAP and HR of the double point group and the single point group were significantly lower than those of the control group(P<0.05), but there were no differences between the double point group and the single point group(P>0.05). The block operation time in the single p

关 键 词：超声引导 竖脊肌平面阻滞 双点阻滞 单点阻滞 腰椎手术 镇痛 

分 类 号：R614[医药卫生—麻醉学]