胸腰筋膜平面阻滞对椎间盘源性腰痛患者围术期镇痛的效果  

Assessing the efficacy of thoracolumbar interfascial plane block for perioperative analgesia in patients with discogenic low back pain

作　　者：韩刘虎 胡军 张荣宜 王立奎[1] HAN Liuhu;HU Jun;ZHANG Rongyi;WANG Likui(Department of Pain,the First Affiliated Hospital of Anhui Medical University,Hefei 230000,China)

机构地区：[1]安徽医科大学第一附属医院疼痛科,合肥230000

出　　处：《实用医学杂志》2024年第10期1370-1375,共6页The Journal of Practical Medicine

基　　金：国家自然科学基金项目(编号:81901086);安徽省自然科学基金项目(编号:1808085MH310)。

摘　　要：目的探讨超声引导下双侧胸腰筋膜平面阻滞(TLIPB)对行经皮椎间孔镜腰椎间盘切除术(PTED)的椎间盘源性腰痛(DLBP)患者的围术期镇痛效果。方法选取57例椎间盘源性腰痛患者,使用计算机生成的随机编号将患者分为A组(对照组)28例患者,B组(超声引导下双侧胸腰筋膜平面阻滞组)29例患者。比较两组患者术前(t_(0))、术后2 h(t_(1))、术后6 h(t_(2))、术后12 h(t_(3))及术后24 h(t_(4))静息和翻身时视觉模拟疼痛评分(VAS)的差异。比较两组患者术前及术后24 h 15项恢复质量评分(QoR-15)的差异。比较两组患者入室后(T_(0))、切皮时(T_(1))、椎间孔成形时(T_(2))、外科医生认定疼痛最剧烈时(T_(3))、手术结束时(T_(4))的平均动脉压(MAP)和心率(HR)变化的差异。记录术中及术后24 h内不良事件。结果所有患者均顺利完成手术和超声引导下双侧TLIPB,无椎间隙感染,无脊髓、神经根和血管损伤,无恶心呕吐等严重并发症。两组患者组内术后各时间点静息及翻身时VAS评分及术后24 h QoR-15评分均较术前显著降低,差异有统计学意义(P<0.05)。两组患者术前及术后各时间点静息时VAS评分差异无统计学意义(P>0.05)。两组患者术后2 h、术后6 h及术后12 h翻身时VAS评分差异有统计学意义(P<0.05),其余时间点差异无统计学意义(P>0.05)。两组患者术前及术后24 h QoR-15评分相比差异有统计学意义(P<0.05),且两组患者术后24 h QoR-15评分相比差异有统计学意义(P<0.05)。两组患者椎间孔成形时(T_(2))和外科医生认定疼痛最剧烈时(T3)时MAP及HR差异有统计学意义(P<0.05)。结论超声引导下双侧胸腰筋膜平面阻滞可以有效缓解PTED术后疼痛,减少围术期应激反应及不良事件的发生,加速患者术后康复。Objective To investigate the perioperative analgesic effect of ultrasound-guided bilateral thora⁃columbar interfascial plane block(TLIPB)in patients with discogenic low back pain(DLBP)undergoing percuta⁃neous transforaminal endoscopic discectomy(PTED).Methods Fifty-seven patients with discogenic low back pain admitted to the First Affiliated Hospital of Anhui Medical University from January 2022 to April 2022 were randomly divided into group A(control group)with 28 patients and group B(ultrasound-guided bilateral thoracolumbar inter⁃fascialinterfacial plane block group)with 29 patients.The differences of visual analogue scale(VAS)at rest and turning over were compared between the two groups preoperative(t_(0)),2 hours postoperative(t_(1)),6 hours postop⁃erative(t_(2)),12 hours postoperative(t_(3))and 24 hours postoperative(t_(4)).The differences of quality of recovery-15 scores(QoR-15)were compared between the two groups preoperative and 24 hours postoperative.The changes of mean arterial pressure(MAP)and heart rate(HR)were compared between the two groups after entering the oper⁃ating room(T_(0)),at the time of skin incision(T1),at the time of foraminoplasty(T_(2)),at the time of the most severe pain recognized by the surgeon(T_(3)),and at the end of the operation(T_(4)).Adverse events were recorded during the operation and within 24 hours postoperative.Results All patients successfully completed the operation and ultrasound-guided bilateral TLIPB,without intervertebral space infection,spinal cord,nerve root and vascular injury,and serious complications such as nausea and vomiting.VAS scores at rest and turning over and QoR-15 scores at 24 hours postoperative were significantly lower than preoperative in the two groups(P<0.05).There was no significant difference in VAS scores between the two groups at rest at preoperative and postoperative time points(P>0.05).There were significant differences in VAS scores at 2 hours,6 hours and 12 hours postoperative between the two groups(P<0.05).There were significa

关 键 词：胸腰筋膜平面阻滞 椎间盘源性腰痛 经皮椎间孔镜腰椎间盘切除术 疼痛 

分 类 号：R441.1[医药卫生—诊断学]