發(fā)布時間：2019-03-19 08:04

【摘要】：目的 :探討不同局部浸潤麻醉方法對經(jīng)皮腰椎內(nèi)窺鏡下手術(shù)中疼痛的控制效果。方法 :2015年2月~2015年6月在我院因腰椎間盤突出癥接受經(jīng)皮內(nèi)窺鏡下腰椎間盤切除術(shù)(PELD)治療的患者納入本研究,隨機分為兩組:A組麻醉方法為濃度1%的利多卡因稀釋溶液局部浸潤麻醉;B組為在A組的基礎(chǔ)上加入鹽酸羅哌卡因注射液100mg局部浸潤麻醉并在手術(shù)開始前靜脈注射枸櫞酸芬太尼注射液0.05mg及鹽酸昂丹司瓊注射液8mg。采用椎間孔成形期VAS評分、纖維環(huán)操作期VAS評分、術(shù)后即刻及術(shù)后24h再手術(shù)意愿評估術(shù)中疼痛控制效果。結(jié)果:共82例患者納入研究,A組42例,B組40例。椎間孔成形期B組在平均疼痛VAS評分(1.1±0.9)及峰值疼痛VAS評分(1.3±0.9)上都顯著低于A組(3.2±2.4及5.1±2.3)。纖維環(huán)相關(guān)操作期兩組間平均疼痛VAS評分和峰值VAS評分無顯著差異。B組術(shù)后即刻再手術(shù)意愿顯著高于A組(95.0%∶71.4%),術(shù)后24h兩組再手術(shù)意愿無顯著差異(97.5%∶97.6%)。兩組患者術(shù)后均未出現(xiàn)麻醉及手術(shù)相關(guān)并發(fā)癥。結(jié)論 :采用利多卡因及羅哌卡因混合局麻聯(lián)合靜脈芬太尼鎮(zhèn)痛的麻醉方案在不增加手術(shù)風險的前提下可顯著改善腰椎內(nèi)鏡手術(shù)術(shù)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 鹵0.9) and peak pain VAS score (1.3 鹵0.9) in group B were significantly lower than those in group A (3.2 鹵2.4 and 5.1 鹵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.
【作者單位】： 北京大學第三醫(yī)院疼痛醫(yī)學中心;
【基金】：國家自然科學基金資助項目(81472041) 北京市衛(wèi)計委首都衛(wèi)生行業(yè)發(fā)展專項基金(2014-2-4094) 北京市科委首都臨床特色應(yīng)用研究(Z141107002514011) 北醫(yī)三院院臨床重點課題(Y66448-09)
【分類號】：R614

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