头颈半棘肌间平面阻滞对颈椎后路手术老年患者围术期应激与镇痛的影响  

Effect of Inter Semispinal Plane Block on Perioperative Stress and Analge⁃sia in Elderly Patients undergoing Posterior Cervical Surgery

作　　者：熊瑞昌[1] 张桦 章扬 胡凯[1] XIONG Ruichang;ZHANG Hua;ZHANG Yang;HU Kai(Department of Anesthesiology,Nanchang Hongdu Hospital of Traditional Chinese Medicine,Nanchang,Jiangxi Prov-ince,330038 China;Department of Anesthesiology,the First Affiliated Hospital of Nanchang University,Nanchang,Jiangxi Province,330006 China)

机构地区：[1]南昌市洪都中医院麻醉科,江西南昌330038 [2]南昌大学第一附属医院麻醉科,江西南昌330006

出　　处：《中外医疗》2024年第6期6-10,共5页China & Foreign Medical Treatment

基　　金：江西省中医药管理局(2023A0261)。

摘　　要：目的探讨头颈半棘肌间平面(Inter Semispinal Plane,ISP)阻滞对颈椎后路手术老年患者围术期应激与镇痛的影响。方法简单随机选取2023年6—9月在南昌市洪都中医院行择期颈椎后路手术的60例老年患者为研究对象,使用随机数表法将患者随机分为研究组和对照组,每组30例,研究组在麻醉诱导前行ISP阻滞,对照组直接进行麻醉诱导。比较两组患者术后1、4、12、24、48 h的静息状态视觉模拟评分(Visual Ana-logue Scale,VAS)、术后48 h内补救镇痛药物使用量、术中镇静镇痛药物使用量、切皮即刻、手术开始后1 h及出室时的心率(Heart Rate,HR)与平均动脉压(Mean Arterial Pressure,MAP)、术后24、48 h血清白介素6(Inter-leukin-6,IL-6)水平,及穿刺相关并发症发生情况。结果研究组术后1、4、12、24 h静息状态VAS评分分别为(6.87±0.90)分、(5.86±1.01)分、(3.23±1.10)分、(2.47±1.28)分,均低于对照组的(8.33±0.95)分、(7.23±1.01)分、(3.97±1.10)分、(3.17±1.10)分,差异有统计学意义(t=6.110、5.255、3.440、4.873,P均<0.05);两组术后48 h的静息状态VAS比较,差异无统计学意义(P>0.05);研究组术后48 h内补救镇痛药物与术中镇静镇痛药物使用量均少于对照组,差异有统计学意义(P均<0.001);研究组切皮即刻、手术开始后1 h及出室时的HR与MAP均低于对照组,差异有统计学意义(P均<0.05)。与对照组比较,研究组术后24、48 h的血清IL-6水平均更低,差异有统计学意义(P均<0.05)。两组患者均未发生穿刺相关并发症。结论ISP阻滞可安全用于颈椎后路手术老年患者,能降低术中应激反应,并能提供充分的术后镇痛。Objective To investigate the effects of inter semispinal plane(ISP)block on perioperative stress and anal-gesia in elderly patients undergoing posterior cervical surgery.Methods A total of 60 elderly patients with underwent elective posterior cervical surgery in Hongdu Hospital of Traditional Chinese Medicine of Nanchang City from June to September 2023 were simple randomly selected as the study subjects.The patients were randomly divided into study group and control group using random number table method,with 30 cases in each group.The study group underwent ISP block before anesthesia induction,while the control group underwent anesthesia induction directly.The resting state Visual Analogue Scale(VAS)at 1,4,12,24,48 h after surgery.The use of remedial analgesic drugs within 48 h after surgery,and the use of intraoperative sedative and analgesic drugs,Heart Rate(HR)and Mean Arterial Pressure(MAP)immediately after skin resection,1 h after operation and at exit,serum interleukin-6(IL-6)levels at 24 and 48 h after surgery,and incidence of puncture related complications were compared between the two groups of patients.Results The resting VAS scores at 1,4,12,24 h after operation were(6.87±0.90)points,(5.86±1.01)points,(3.23±1.10)points and(2.47±1.28)points,respectively,which were lower than those in the control group(8.33±0.95)points,(7.23±1.01)points,(3.97±1.10)points,(3.17±1.10)points,and the differences were statistically significant(t=6.110,5.255,3.440,4.873,all P<0.05).There was no significant difference in resting VAS at 48 h after surgery between the two groups(P>0.05).The amount of remedial analgesic drugs and intraoperative sedative and analgesic drugs used in the study group were less than those in the control group within 48 h after surgery,and the differences were statisti-cally significant(both P<0.001).HR and MAP of the study group were lower than those of the control group immedi-ately after incision,1 h after operation and at the time of leaving the room,and the differences were statistically

关 键 词：头颈半棘肌间平面阻滞 颈椎后路手术 镇痛 应激 

分 类 号：R614[医药卫生—麻醉学]