本文選題：腰椎間盤突出癥　切入點(diǎn)：經(jīng)皮椎間孔鏡下腰椎間盤切除術(shù)　出處：《天津醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：背景:經(jīng)皮椎間孔鏡下腰椎間盤切除術(shù)(Transforaminal Endoscopic SurgerSystem,TESSYS)是當(dāng)前世界上治療腰椎間盤突出癥的主流手術(shù)技術(shù)。為提高手術(shù)安全性,減少術(shù)中神經(jīng)根副損傷機(jī)率,目前大部分醫(yī)生在開展TESSYS技術(shù)時(shí)都采取局部浸潤(rùn)麻醉的方式。然而,局麻的方式并不能很好的降低患者術(shù)中疼痛感,甚至于部分患者因?yàn)椴荒苣褪苄g(shù)中疼痛,而被迫放棄治療。為了降低患者術(shù)中疼痛感,改善治療體驗(yàn),并減少因疼痛所致的相關(guān)并發(fā)癥的出現(xiàn)機(jī)率,醫(yī)生們開展了大量的探索工作。目前,尚少有在TESSYS術(shù)中應(yīng)用連續(xù)硬膜外麻醉的方式進(jìn)行鎮(zhèn)痛治療的相關(guān)報(bào)道。目的:通過(guò)局麻及連續(xù)硬膜外麻醉下,患者在腰椎椎間孔鏡術(shù)中、術(shù)后各項(xiàng)指標(biāo)的對(duì)比分析,探討連續(xù)硬膜外麻醉在TESSYS治療中應(yīng)用的意義。方法:2016年1月~2016年7月期間因腰椎間盤突出癥接受單節(jié)段TESSYS治療的患者納入本研究,隨機(jī)分為兩組:A組麻醉方法為應(yīng)用濃度為0.2%的羅哌卡因與0.4%的利多卡因混合溶液,于治療過(guò)程中對(duì)各層次組織結(jié)構(gòu)進(jìn)行局部浸潤(rùn)麻醉;B組麻醉方法為應(yīng)用濃度為0.3%的羅哌卡因,于治療過(guò)程中進(jìn)行椎管內(nèi)連續(xù)硬膜外麻醉。記錄患者手術(shù)時(shí)間,術(shù)中X射線量,術(shù)前腰、腿痛VAS評(píng)分,術(shù)中腰、腿痛VAS評(píng)分,術(shù)后48小時(shí)腰、腿痛VAS評(píng)分等,并應(yīng)用SPSS 19.0軟件進(jìn)行統(tǒng)計(jì)分析。結(jié)果:共101例患者納入研究,A組45例,其中42例順利完成研究,3例因術(shù)中疼痛及相關(guān)并發(fā)癥脫落;B組56例,均順利完成研究。最終98例患者順利完成本研究,A組42例,B組56例。兩組術(shù)后48小時(shí)腰、腿痛VAS評(píng)分A組(1.93±0.712,1.57±1.579),B組(1.18±0.811,1.25±1.643)均顯著低于術(shù)前A組(4.88±2.725,8.71±1.954),B組(5.20±3.153,8.23±2.054),差異有統(tǒng)計(jì)學(xué)意義(P≤0.05)。B組在手術(shù)時(shí)間(64.91±24.981min),術(shù)中X射線量(4.61±3.073m GY)及術(shù)中腰、腿痛VAS評(píng)分(1.25±1.164,1.38±1.484)上都顯著低于A組(118.71±24.598min、14.77±3.095m GY,4.67±1.183,5.67±1.883),差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:在連續(xù)硬膜外麻醉下進(jìn)行腰椎單節(jié)段TESSYS手術(shù)治療,不僅能達(dá)到與局麻手術(shù)同樣良好的療效,而且能夠較好的改善患者術(shù)中的疼痛體驗(yàn),縮短手術(shù)時(shí)間,減少患者及醫(yī)生的X射線接觸量,具有較好的推廣價(jià)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 鹵0.712 鹵1.57 鹵1.579) was 1.18 鹵0.8111.25 鹵1.643) significantly lower than that in group A (4.88 鹵2.7258.71 鹵1.954) and in group B (5.20 鹵3.153 鹵8.23 鹵2.054). The difference was statistically significant (P 鈮，

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