椎间孔浸润麻醉在椎间孔镜术中的镇痛效果

发布时间：2018-03-17 01:31

本文选题：腰椎间盘突出症　切入点：经皮椎间孔镜椎间盘切除术　出处：《中国矫形外科杂志》2017年23期 　论文类型：期刊论文

【摘要】：[目的]探讨辅助椎间孔周围浸润麻醉对经皮腰椎间孔镜髓核摘除术中镇痛的疗效。[方法]将64例单节段腰椎间孔镜下髓核摘除术治疗的患者随机分为椎间孔浸润组和逐层浸润组。椎间孔浸润组于棘突旁开约4 cm予0.5%利多卡因行关节突外侧及椎间孔浸润麻醉;逐层浸润组采用逐层利多卡因浸润麻醉。记录两组手术时间、透视次数,采用视觉模拟评分法(visual analogue scale,VAS)评估椎间孔成形及后纵韧带处理时的疼痛,采用Likert五分量表法评价患者对局麻手术的体验,并对再手术意愿进行调查。[结果]椎间孔浸润组患者均顺利完成手术,逐层浸润组有3例术中在椎间孔成形时由于不能耐受疼痛而临时增加静脉强化镇痛;两组手术时间、透视次数差异不具有统计学意义(P0.05);椎间孔浸润组椎间孔成形VAS评分为(4.74±1.05)分,逐层浸润组(7.48±1.16)分,差异有统计学意义(P0.05)。后纵韧带处理时椎间孔浸润组VAS评分(3.74±0.62)分,逐层浸润组(5.22±0.80)分,差异具有统计学意义(P0.05);椎间孔浸润组的局麻体验评价选择好和很好的占75.00%,而逐层浸润组仅31.25%;再手术意愿椎间孔浸润组为87.00%,而逐层浸润组为46.88%,差异具有统计学意义(P0.05)。[结论]辅助椎间孔周围浸润麻醉可以显著减少椎间孔镜术中的疼痛,且操作简单,安全性高。
[Abstract]:[objective] to investigate the analgesic effect of assisted periforaminal infiltration anesthesia in percutaneous lumbar foramellar nucleus pulpotomy. [methods] Sixty-four patients undergoing single segmental intervertebral foramen endoscopy were randomly divided into intervertebral foramen dipping. The intervertebral foramen infiltration group was treated with 0.5% lidocaine to anaesthesia of lateral articular process and intervertebral foramen. Laminar infiltration group was anesthetized by layer by layer lidocaine. The operation time, fluoroscopy times and visual analogue score were used to evaluate the pain of intervertebral foramination and posterior longitudinal ligament treatment. The experience of local anaesthesia was evaluated by Likert quintile scale, and the willingness of reoperation was investigated. [results] all the patients in the intervertebral foramen infiltration group completed the operation successfully. In the laminar infiltrating group, 3 cases were temporarily increased intravenous analgesia during intervertebral foramination because of their intolerable pain. There was no significant difference in the operation time between the two groups (P 0.05), and the VAS score of intervertebral foramen formation in the intervertebral foramen infiltration group was 4.74 卤1.05). The VAS score of the intervertebral foramen infiltration group was 3.74 卤0.62 when the posterior longitudinal ligament was treated, and 5.22 卤0.80 in the layer by layer infiltration group. The difference was statistically significant (P 0.05), the local anesthetic experience evaluation in the intervertebral foramen infiltration group was 75.00%, while that in the layer-by-layer infiltration group was only 31.25%, and that in the intervertebral foramen infiltration group was 87.00 and 46.88, respectively. The difference was statistically significant. [conclusion] Auxiliary periforaminal infiltration anesthesia can significantly reduce the pain in intervertebral foramen surgery. And the operation is simple, the security is high.
【作者单位】：福建医科大附属第二医院骨科;
【分类号】：R614

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