机构地区:[1]韶关市第一人民医院麻醉科,广东韶关512000
出 处:《吉林医学》2025年第4期791-795,共5页Jilin Medical Journal
基 金:2023年度韶关市支持科研工作者项目[项目编号:230330098033595]。
摘 要:目的:探究不同控制性降压方法对大通道脊柱内镜辅助下腰椎融合术(Delta大通道下Endo-P/TLIF)术后炎性因子和疼痛的影响。方法:选取2023年8月~2024年3月韶关市第一人民医院收治的60例择期行Delta大通道下Endo-P/TLIF术的患者,按随机数字法分为对照组和观察组各30例,对照组采用麻醉药物控制性降压,观察组采用血管活性药物控制性降压。评估两组临床指标、血流动力学、炎性因子水平、镇痛效果及不良反应。结果:观察组的麻醉药物用量、术中出血量、手术时间均少于对照组,差异有统计学意义(P<0.05)。控制性降压结束前、术毕1 h两组患者的IL-6、TNF-α均高于控制降压前,且观察组降压结束前、术毕1 h的IL-6、TNF-α水平低于对照组,差异均有统计学意义(P<0.05);观察组的控制性降压结束前、术毕1 h的IL-10水平均高于对照组,差异有统计学意义(P<0.05)。观察组在T1时的SBP、DBP水平均低于T0时,差异均有统计学意义(P<0.05),但T0时和T2时的SBP、DBP水平对比差异无统计学意义(P>0.05);而对照组在T0、T1、T2时的SBP、DBP水平对比差异无统计学意义(P>0.05)。对照组在T1、T2时的MAP、HR水平均低于T0时,但观察组在T0、T1、T2时的MAP、HR水平对比差异无统计学意义(P>0.05)。术毕30 min、1 h观察组的VAS评分均低于对照组,差异有统计学意义(P<0.05)。观察组不良反应发生率低于对照组,差异有统计学意义(P<0.05)。结论:相较于麻醉药物控制性降压,在Delta大通道下Endo-P/TLIF术采用血管活性药物控制性降压效果良好,可缩短手术时间,减少术中出血量及麻醉药物用量,改善术后炎症反应,具有较佳的镇痛效果,术中血流动力学更平稳,且安全性高。Objective To investigate the effects of different controlled antihypertensive methods on inflammatory factors and pain after endoscopy-assisted lumbar fusion in large channel spine(Endo-P/TLIF under Delta channel).Methods 90 patients admitted to our hospital from August 2023 to March 2024 who underwent Endo-P/TLIF under Delta channel were selected and divided into a control group and observation group by random number method(n=30).The control group was treated with anesthetic drugs to control hypotension,the observation group was treated with vasoactive drugs to control hypotension.Clinical indicators,levels of inflammatory factors,analgesic effect,and adverse reactions were evaluated.Results The amount of anesthetic drugs,intraoperative blood loss,and operation time in the observation group were lower than in the control group(P<0.05).The levels of IL-6 and TNF-α in the 2 groups were higher than those before controlled hypotension and 1 hour after surgery(P<0.05).However,the levels of IL-6 and TNF-α in the observation group were lower than those in the control group before hypotension and 1 hour after surgery(P<0.05).The IL-10 level in the observation group was higher than that in the control group before the end of controlled hypotension and 1 hour after surgery(P<0.05).The levels of SBP and DBP in the combination group at T1 were lower than those at T0(P<0.05),but there was no significant difference between the levels of SBP and DBP at T0 and T2(P>0.05),while there was no significant difference between the levels of SBP and DBP at T0,T1 and T2(P>0.05).The levels of MAP and HR in the control group at T1 and T2 were lower than those at T0,but there was no significant difference in the levels of MAP and HR in the combination group at T0,T1,and T2(P>0.05).VAS scores in the observation group were lower than those in the control group 30 minutes and 1 hour after operation(P<0.05).The incidence of adverse reactions in the observation group was lower than that in the control group(P<0.05).Conclusions Compared with a
关 键 词:控制性降压 麻醉药物 血管活性药物 大通道脊柱内镜辅助下腰椎融合术 炎性因子
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