不同麻醉方法下经椎间孔镜髓核摘除术患者的舒适度与安全性研究

金学廷; 查晓亮; 邱振红; 陈芳; 张荣宜; 王立奎

doi:10.16766/j.cnki.issn.1674-4152.002092

不同麻醉方法下经椎间孔镜髓核摘除术患者的舒适度与安全性研究

doi: 10.16766/j.cnki.issn.1674-4152.002092

1.
安徽医科大学附属巢湖医院疼痛科，安徽巢湖 238000
2.
安徽医科大学第一附属医院疼痛科，安徽合肥 230031

基金项目:

安徽省自然科学基金项目 1808085MH310

详细信息

通讯作者:
张荣宜，E-mail: rongyiz@126.com

中图分类号: R614 R687.41
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出版历程
- 收稿日期: 2020-09-24
- 网络出版日期: 2022-02-15

Comfort and safety of patients undergoing percutaneous endoscopic lumbar discectomy with different anaesthesia methods

1.
Department of Anesthesiology, Chaohu Hospital Affiliated to Anhui Medical University, Chaohu, Anhui 238000, China

摘要

摘要: 目的探讨不同麻醉方法对接受经椎间孔镜髓核摘除术(percutaneous endoscopic lumbar discectomy，PELD)的患者术中舒适度与安全性的影响。方法选取2017年2月—2020年5月安徽医科大学附属巢湖医院疼痛科拟行PELD术的腰椎间盘突出症患者60例，采用随机数字表法分为试验组(M组)和对照组(L组)，每组30例，2组患者除麻醉方法不同外，均使用同一厂家的手术器械，采用相同手术方法、手术步骤和监测指标。L组使用0.5%的利多卡因行局部浸润麻醉，M组在L组的基础上，持续静脉泵注右美托咪定和瑞芬太尼。分别记录入室(T0)、术中穿刺(T1)、椎间孔扩大成形(T2)、镜下操作(T3)这4个时间段患者腰背部疼痛的NRS评分、MAP和HR的最大值，计算T1、T2、T3时MAP、HR较T0时的变化率，记录术中呼吸抑制、术后呕吐、尿潴留发生情况；术后对患者进行满意度调查。结果 2组患者在术中操作时腰背部均出现疼痛，与L组比较，M组患者的NRS疼痛评分明显降低，术中MAP、HR的变化率(ΔMAP、ΔHR)比较，差异有统计学意义(均P＜0.05)；2组患者术中呼吸抑制、术后尿潴留、术后呕吐发生率间比较，差异无统计学意义(均P>0.05)；M组满意度评分为(8.2±0.9)分，明显高于L组的(4.1±1.1)分，差异有统计学意义(P＜0.05)。结论静脉辅助镇痛镇静下行PELD术，患者可获得更好的镇痛镇静效果，舒适度明显提高，且不增加并发症的发生率，安全性高，值得临床推广。
- 经皮椎间孔镜下髓核摘除术 /
- 麻醉监护 /
- 瑞芬太尼 /
- 右美托咪定
Abstract: Objective To investigate the effects of different anaesthesia methods on the comfort and safety of patients undergoing percutaneous endoscopic lumbar discectomy (PELD). Methods From February 2017 to May 2020, 60 patients with lumbar intervertebral disc herniation who planned to undergo PELD in the Department of Pain, Chaohu Hospital, Anhui Medical University, were divided into experimental group (M group) and control group (L) using a random number table method, with 30 cases in each group. In addition to the different anaesthesia methods, the surgical instruments, surgical methods and monitoring indicators used in both groups were the same. The L group was treated with 0.5% lidocaine for local infiltration anaesthesia, whilst the M group received continuous intravenous injection of dexmedetomidine and remifentanil on the basis of the L group. The NRS score, maximum value of MAP and HR of patients with low back pain in four time periods, entrance (T0), intraoperative puncture (T1), foramen expansion (T2) and microscopic operation (T3) were recorded. The rate of change of MAP and HR at T1, T2 and T3 compared with T0 was calculated. The occurrence of respiratory depression, postoperative vomiting and urinary retention during the operation was recorded. The satisfaction survey of patients was carried out after the operation. Results Both groups of patients had pain in the lower back and back during the operation. Compared with the L group, the NRS pain score of the M group was significantly lower. Compared with the change rate of MAP and HR (ΔMAP, ΔHR), the difference was statistically significant (all P < 0.05). Comparing the two groups of patients, no statistically significant difference was observed in the incidence of intraoperative respiratory depression, postoperative urinary retention and postoperative vomiting (all P>0.05). The satisfaction score of the M group [(8.2±0.9) points] was significantly higher than that [(4.1±1.1) points] of the L group, and the difference was statistically significant (P < 0.05). Conclusion PELD with intravenous-assisted analgesia and sedation can provide patients with better analgesia and sedation, with significantly improved comfort. Moreover, it does not increase the incidence of complications, has high safety and is worthy of clinical promotion.
- Percutaneous endoscopic lumbar discectomy /
- Monitoring anaesthesia care /
- Remifentanil /
- Dexmedetomidine

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表 1 2组腰椎间盘突出症患者术前一般资料比较(x±s)

组别	例数	年龄(岁)	BMI	手术时间(min)
M组	30	53.9±13.7	22.3±1.4	85.5±6.3
L组	30	56.6±12.9	22.4±1.5	87.1±9.1
t值		-0.793	-0.333	0.541
P值		0.431	0.741	0.591

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表 2 2组腰椎间盘突出症患者NRS评分、MAP、HR变化率比较(x±s)

组别	例数	NRS评分				ΔMAP(%)				ΔHR(%)
组别	例数	T0	T1	T2	T3	T0	T1	T2	T3	T0	T1	T2	T3
M组	30	0	1.9±0.8^a	3.3±0.6^ab	2.3±0.8^a	0	9.7±1.9^a	12.1±1.5^ab	10.2±1.9^a	0	8.8±3.9^a	10.5±5.5^ab	9.6±4.8^a
L组	30	0	4.5±0.7^a	5.8±1.1^ab	4.2±0.7^a	0	21.1±3.5^a	25.3±3.8^ab	22.8±6.2^a	0	25.4±9.9^a	25.5±9.7^a	24.7±8.6^a
t值			-12.024	-10.175	-8.791		-14.091	-16.261	-9.709		-7.700	-6.577	-7.549
P值			0.034	0.023	0.016		＜0.001	＜0.001	＜0.001		＜0.001	＜0.001	＜0.001
注：与T0时比较，^aP＜0.05；与同组T1和T3时刻比较，^bP＜0.05。

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表 3 2组腰椎间盘突出症患者手术并发症比较(例)

组别	例数	呼吸抑制	呕吐	尿潴留
M组	30	3	2	2
L组	30	0	0	3
χ²值		1.404	0.517	< 0.001
P值		0.236	0.472	0.999

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