腰椎融合术中应用艾司氯胺酮复合竖脊肌平面阻滞对围术期低阿片类药物镇痛效果的影响  

Effect of Esketamine combined with Erector Ridge Muscle Plane Block on Perioperative Opioid Analgesia during Lumbar Fusion

作　　者：谢珍桂 李耀松[1] 廖建平 XIE Zhen-Gui;LI Yao-Song;LIAO Jian-Ping(Department of Anesthesiology,Guigang People's Hospital,Guigang 537100,China)

机构地区：[1]贵港市人民医院麻醉科,广西贵港537100

出　　处：《中国药物经济学》2025年第2期67-71,76,共6页China Journal of Pharmaceutical Economics

基　　金：广西壮族自治区卫生健康委员会科研项目(Z-R20241688);湖北陈孝平科技发展基金会项目(CXPJJH124001-07)。

摘　　要：目的探讨腰椎融合术中应用艾司氯胺酮复合竖脊肌平面阻滞对围术期低阿片类药物镇痛效果的影响。方法选取2024年1—10月于贵港市人民医院脊柱关节外科择期行后入路腰椎融合术治疗(1~2个节段腰椎)的64例患者,随机分为对照组(32例,传统阿片类药物全身麻醉)与试验组(32例,艾司氯胺酮复合竖脊肌阻滞的低阿片类药物全身麻醉),比较两组患者的麻醉效果。结果试验组瑞芬太尼用量、术后首次按压镇痛泵时间和按压次数、用氢吗啡酮补救镇痛总量优于对照组(P<0.05);麻醉诱导气管插管前1 min(T_(0))、气管插管后1 min(T_(1))时试验组收缩压(SBP)、舒张压(DBP)高于对照组(P<0.05),手术准备切皮前1 min(T_(2))、手术开始切皮后1 min(T_(3))时试验组SBP、DBP与对照组比较差异无统计学意义(P>0.05),T_(0)、T_(1)、T_(2)、T_(3)时试验组心率(HR)高于对照组(P<0.05);试验组自控静脉镇痛(PCIA)躁动发生率与对照组比较无差异(P>0.05);试验组静息时数字评分法(NRS)评分(术后2 h、6 h、12 h、24 h、48 h)低于对照组(P<0.05),试验组运动(咳嗽)时NRS评分(术后2 h、6 h)低于对照组(P<0.05),试验组运动(咳嗽)时NRS评分(术后12 h、24 h)低于对照组(P>0.05),试验组运动(咳嗽)时NRS评分(术后48 h)低于对照组(P<0.05);术后24 h、48 h试验组15项恢复质量评分量表(RoQ-15)评分高于对照组(P<0.05);两组均未发生阻滞相关并发症(局麻药中毒反应、血肿、神经损伤、腹腔内脏器损伤、穿刺点感染);试验组术后不良反应发生率低于对照组(P>0.05)。结论艾司氯胺酮复合竖脊肌平面阻滞应用于腰椎融合术围术期中,能有效减少阿片类药物的使用剂量,减少其的不良反应,维持血流动力学稳定,加速患者术后康复。Objective To explore the effect of esketamine combined with erector ridge muscle plane block on perioperative analgesia of opioids during lumbar fusion.Methods A total of 64 patients were selected to receive posterior approach lumbar fusion(1-2 lumbar segments)at the Department of Spine and Joint Surgery of Guigang People's Hospital from January to October2024 were randomly divided into control group(32 cases with traditional opioid general anesthesia)and experimental group(32cases with low opioid general anesthesia with esketamine combined with erectus block).The anesthetic effect of the two groups was compared.Results The dosage of remifentanil,the first time and times of pressing the analgesic pump,and the total amount of analgesic relief with hydromorphone in experimental group were better than those in control group(P<0.05).Systolic blood pressure(SBP)and diastolic blood pressure(DBP)in experimental groups were higher than those in control group at 1 min before anesthesia induction tracheal intubation(T_(0))and 1 min after tracheal intubation(T_(1))(P<0.05).There was no significant difference in SBP and DBP between the experimental group and the control group 1 min before operation(T_(2))and 1 min after operation(T_(3))(P>0.05).The heart rate(HR)of the experimental group was higher than that of the control group at T_(0),T_(1),T_(2)and T_(3)(P<0.05).There was no difference in the incidence of PCIA agitation between experimental group and control group(P>0.05).The NRS score at rest(2 h,6 h,12 h,24 h,48 h)of experimental group was lower than that of control group(P<0.05),and the NRS score during exercise(cough)of experimental group(2 h,6 h)was lower than that of control group(P<0.05),the NRS score(12 h,24 h)during exercise(cough)in experimental group was lower than that in control group(P>0.05),and the NRS score(48 h)during exercise(cough)in experimental group was lower than that in control group(P<0.05).The scores of 15 items of recovery quality Scale(RoQ-15)in experimental group were higher than those in con

关 键 词：艾司氯胺酮 竖脊肌平面阻滞 腰椎融合术 低阿片类药物镇痛 

分 类 号：R687.4[医药卫生—骨科学] R971[医药卫生—外科学]