经皮腰椎内窥镜下手术麻醉方案选择的前瞻性随机对照研究

发布时间：2019-03-19 08:04

【摘要】：目的 :探讨不同局部浸润麻醉方法对经皮腰椎内窥镜下手术中疼痛的控制效果。方法 :2015年2月~2015年6月在我院因腰椎间盘突出症接受经皮内窥镜下腰椎间盘切除术(PELD)治疗的患者纳入本研究,随机分为两组:A组麻醉方法为浓度1%的利多卡因稀释溶液局部浸润麻醉;B组为在A组的基础上加入盐酸罗哌卡因注射液100mg局部浸润麻醉并在手术开始前静脉注射枸橼酸芬太尼注射液0.05mg及盐酸昂丹司琼注射液8mg。采用椎间孔成形期VAS评分、纤维环操作期VAS评分、术后即刻及术后24h再手术意愿评估术中疼痛控制效果。结果:共82例患者纳入研究,A组42例,B组40例。椎间孔成形期B组在平均疼痛VAS评分(1.1±0.9)及峰值疼痛VAS评分(1.3±0.9)上都显著低于A组(3.2±2.4及5.1±2.3)。纤维环相关操作期两组间平均疼痛VAS评分和峰值VAS评分无显著差异。B组术后即刻再手术意愿显著高于A组(95.0%∶71.4%),术后24h两组再手术意愿无显著差异(97.5%∶97.6%)。两组患者术后均未出现麻醉及手术相关并发症。结论 :采用利多卡因及罗哌卡因混合局麻联合静脉芬太尼镇痛的麻醉方案在不增加手术风险的前提下可显著改善腰椎内镜手术术中疼痛控制。
[Abstract]:Objective: to investigate the effect of different local infiltration anesthesia on pain control in percutaneous endoscopic lumbar surgery. Methods: from February 2015 to June 2015, patients who underwent percutaneous endoscopic lumbar disc resection (PELD) for lumbar disc herniation in our hospital were included in this study. Two groups were randomly divided into two groups: group A was anesthetized with 1% lidocaine diluted solution for local infiltration; Group B received local infiltration anesthesia with ropivacaine hydrochloride injection 100mg and intravenous injection of fentanyl citrate (0.05mg) and ondansetron hydrochloride (8 mg 路L-1) before the beginning of the operation. The effect of pain control was evaluated by VAS score in intervertebral foramen formative stage, VAS score in fibroring operation stage, immediate and 24 hours postoperative reoperation intention. Results: 82 patients were included in the study, group A (n = 42) and group B (n = 40). The mean pain VAS score (1.1 卤0.9) and peak pain VAS score (1.3 卤0.9) in group B were significantly lower than those in group A (3.2 卤2.4 and 5.1 卤2.3) during the formative period of intervertebral foramen. There was no significant difference in the mean pain VAS score and peak VAS score between the two groups during the operation period. The immediate reoperation intention in group B was significantly higher than that in group A (95.0% / 71.4%). There was no significant difference in reoperation intention between the two groups 24 hours after operation (97.5% vs 97.6%). There were no anesthesia and operation-related complications in both groups. Conclusion: Lidocaine combined with ropivacaine combined with intravenous fentanyl can significantly improve pain control during endoscopic lumbar surgery without increasing the risk of operation.
【作者单位】：北京大学第三医院疼痛医学中心;
【基金】：国家自然科学基金资助项目(81472041) 北京市卫计委首都卫生行业发展专项基金(2014-2-4094) 北京市科委首都临床特色应用研究(Z141107002514011) 北医三院院临床重点课题(Y66448-09)
【分类号】：R614

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