连续硬膜外麻醉在腰椎椎间孔镜手术治疗中应用的前瞻性研究

发布时间：2018-03-14 22:15

  本文选题：腰椎间盘突出症　切入点：经皮椎间孔镜下腰椎间盘切除术　出处：《天津医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景:经皮椎间孔镜下腰椎间盘切除术(Transforaminal Endoscopic SurgerSystem,TESSYS)是当前世界上治疗腰椎间盘突出症的主流手术技术。为提高手术安全性,减少术中神经根副损伤机率,目前大部分医生在开展TESSYS技术时都采取局部浸润麻醉的方式。然而,局麻的方式并不能很好的降低患者术中疼痛感,甚至于部分患者因为不能耐受术中疼痛,而被迫放弃治疗。为了降低患者术中疼痛感,改善治疗体验,并减少因疼痛所致的相关并发症的出现机率,医生们开展了大量的探索工作。目前,尚少有在TESSYS术中应用连续硬膜外麻醉的方式进行镇痛治疗的相关报道。目的:通过局麻及连续硬膜外麻醉下,患者在腰椎椎间孔镜术中、术后各项指标的对比分析,探讨连续硬膜外麻醉在TESSYS治疗中应用的意义。方法:2016年1月~2016年7月期间因腰椎间盘突出症接受单节段TESSYS治疗的患者纳入本研究,随机分为两组:A组麻醉方法为应用浓度为0.2%的罗哌卡因与0.4%的利多卡因混合溶液,于治疗过程中对各层次组织结构进行局部浸润麻醉;B组麻醉方法为应用浓度为0.3%的罗哌卡因,于治疗过程中进行椎管内连续硬膜外麻醉。记录患者手术时间,术中X射线量,术前腰、腿痛VAS评分,术中腰、腿痛VAS评分,术后48小时腰、腿痛VAS评分等,并应用SPSS 19.0软件进行统计分析。结果:共101例患者纳入研究,A组45例,其中42例顺利完成研究,3例因术中疼痛及相关并发症脱落;B组56例,均顺利完成研究。最终98例患者顺利完成本研究,A组42例,B组56例。两组术后48小时腰、腿痛VAS评分A组(1.93±0.712,1.57±1.579),B组(1.18±0.811,1.25±1.643)均显著低于术前A组(4.88±2.725,8.71±1.954),B组(5.20±3.153,8.23±2.054),差异有统计学意义(P≤0.05)。B组在手术时间(64.91±24.981min),术中X射线量(4.61±3.073m GY)及术中腰、腿痛VAS评分(1.25±1.164,1.38±1.484)上都显著低于A组(118.71±24.598min、14.77±3.095m GY,4.67±1.183,5.67±1.883),差异有统计学意义(P0.05)。结论:在连续硬膜外麻醉下进行腰椎单节段TESSYS手术治疗,不仅能达到与局麻手术同样良好的疗效,而且能够较好的改善患者术中的疼痛体验,缩短手术时间,减少患者及医生的X射线接触量,具有较好的推广价值。
[Abstract]:Background: Transforaminal Endoscopic Surger system (TESSYSs) is the main surgical technique for the treatment of lumbar disc herniation under percutaneous foraminal endoscopy. In order to improve the safety of the operation and reduce the chance of nerve root collateral injury during the operation, transforaminal Endoscopic SurgerSystem-TESSYSs is the main technique in the treatment of lumbar disc herniation. At present, most doctors adopt the method of local infiltration anesthesia when developing TESSYS technique. However, the local anesthesia method can not reduce the patients' pain during operation, even some patients can not tolerate intraoperative pain. In order to reduce the pain, improve the treatment experience, and reduce the incidence of related complications caused by pain, doctors have carried out a lot of research work. There are few reports on the analgesic treatment of continuous epidural anesthesia during TESSYS. Objective: to compare and analyze the postoperative indexes of patients under local anesthesia and continuous epidural anesthesia during lumbar intervertebral foramen surgery. To explore the significance of continuous epidural anesthesia in the treatment of TESSYS methods: from January 2016 to July 2016, patients receiving single segment TESSYS for lumbar disc herniation were included in this study. Two groups were randomly divided into two groups: ropivacaine (0.2%) and lidocaine (0.4%). During the course of treatment, local infiltration anesthesia was performed in each level of tissue structure. Group B was anesthetized with ropivacaine (0.3%). Continuous epidural anesthesia was performed during the treatment. The time of operation, the amount of X ray, the VAS score of preoperative waist and leg pain, the VAS score of intraoperative waist and leg pain, the 48 hours after operation and the VAS score of leg pain were recorded. SPSS 19.0 software was used for statistical analysis. Results: a total of 101 patients were included in the study group A 45 cases, 42 cases successfully completed the study 3 cases due to intraoperative pain and related complications abscission group B 56 cases, Finally, 98 patients were successfully completed in group A, 42 cases in group A, 56 cases in group B. 48 hours after operation, 56 cases in group A, The VAS score of leg pain in group A (1.93 卤0.712 卤1.57 卤1.579) was 1.18 卤0.8111.25 卤1.643) significantly lower than that in group A (4.88 卤2.7258.71 卤1.954) and in group B (5.20 卤3.153 卤8.23 卤2.054). The difference was statistically significant (P 鈮，

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