罗哌卡因联合利多卡因行切口浸润麻醉在腰椎融合手术中的应用  

Application of Ropivacaine combined with Lidocaine for incision infiltration anesthesia in lumbar fusion surgery

作　　者：刘平平 金凤 李锦军[1] 费琦[1] 孟海[1] Liu Pingping;Jin Feng;Li Jinjun;Fei Qi;Meng Hai(Department of Orthopedics,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院骨科,北京100050

出　　处：《国际外科学杂志》2024年第10期704-709,F0004,共7页International Journal of Surgery

摘　　要：目的探讨罗哌卡因联合利多卡因行切口浸润麻醉在腰椎融合手术中应用的有效性和安全性。方法回顾性分析2021年3月—2023年9月于首都医科大学附属北京友谊医院骨科行腰椎融合手术治疗的154例腰椎退变性疾病患者的病例资料,根据是否行罗哌卡因联合利多卡因切口浸润麻醉将患者分为试验组(n=72)和对照组(n=82)。试验组患者采用罗哌卡因联合利多卡因切口浸润麻醉,对照组患者未采用切口浸润麻醉。比较两组患者术后6个时间点(即术后2、4、6、12、24、48 h)的静态及动态疼痛视觉模拟评分(VAS),术后镇痛药物应用情况以及相关并发症。正态分布的计量资料以均数±标准差(±s)表示,组间比较采用t检验;非正态分布的计量资料以中位数(四分位间距)[M(Q_(1),Q_(3))]表示,组间比较采用非参数检验;计数资料以例数和百分比[例(%)]表示,组间比较采用χ^(2)检验。结果所有患者均顺利完成手术,试验组患者术后2、4、6、12 h的静态[(4.40±1.67)、(3.86±1.22)、(3.58±1.15)、(3.43±1.11)分]及动态[(4.56±1.69)、(4.03±1.21)、(3.79±1.16)、(3.65±1.13)分]VAS评分均低于对照组[静态:(5.38±1.73)、(5.06±1.58)、(4.68±1.37)、(3.82±1.22)分;动态:(5.55±1.62)、(5.29±1.50)、(4.89±1.41)、(4.12±1.29)分],差异均具有统计学意义(P<0.05);术后24、48 h,两组患者的静态及动态VAS评分比较,差异均无统计学意义(P>0.05);试验组患者术后48 h口服曲马朵[100(0,100)mg]及皮下注射吗啡用量[0(0,0)mg]均显著低于对照组[100(100,100)、0(0,10)mg],差异均具有统计学意义(P<0.05);两组患者术后切口并发症及脑脊液漏发生率比较,差异均无统计学意义(P>0.05)。结论罗哌卡因联合利多卡因行切口浸润麻醉应用于腰椎融合手术中可以有效缓解术区早期的疼痛,减少术后镇痛药物的应用,且不会增加相关并发症。ObjectiveTo investigate the efficacy and safety of Ropivacaine combined with Lidocaine for incision infiltration anesthesia in lumbar fusion surgery.MethodsThe case data of 154 patients with lumbar degenerative diseases who underwent lumbar fusion surgery at the Department of Orthopedics,Beijing Friendship Hospital,Capital Medical University from March 2021 to September 2023 were retrospectively analyzed,and the patients were divided into the experimental group(n=72)and the control group(n=82)according to whether or not they underwent Ropivacaine combined with Lidocaine incisional infiltration anesthesia.The experimental group was anesthetized with Ropivacaine combined with Lidocaine incisional infiltration anesthesia,and the control group was not anesthetized with incisional infiltration.The static and dynamic pain visual analog score(VAS)at six postoperative time points(2,4,6,12,24,48 h after surgery),the application of postoperative analgesic medications,and related complications were compared between the two groups.The measurement data of normal distribution were expressed as mean±standard deviation(±s),and t-test was used for comparison between groups,the measurement data of non-normal distribution were expressed as median(interquartile distance)[M(Q 1,Q 3)],and non-parametric test was used for comparison between groups;the count data were expressed as the number of cases and percentage,and the Chi-square test was used for comparison between groups.ResultsAll patients underwent successful surgery,and the static[(4.40±1.67),(3.86±1.22),(3.58±1.15),(3.43±1.11)points]and dynamic[(4.56±1.69),(4.03±1.21),(3.79±1.16),(3.65±1.13)points]VAS scores of the patients in the experimental group were lower than those in the control group[static:(5.38±1.73),(5.06±1.58),(4.68±1.37),(3.82±1.22)points;dynamic:(5.55±1.62),(5.29±1.50),(4.89±1.41),(4.12±1.29)points]at 2,4,6,12 h after surgery,and the differences were statistically significant(P<0.05);at 24,48 h after surgery,there was no significant difference i

关 键 词：麻醉 腰椎 脊柱融合术 罗哌卡因 利多卡因 

分 类 号：R614[医药卫生—麻醉学]