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| 超声引导下竖脊肌平面阻滞对腰椎后路手术全麻效果及术后恢复的影响 |
| Ultrasound-guided erector spine block as an adjuvant to general anesthesia and postoperative analgesia in patients undergoing lumbar spine surgery |
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| DOI：10.12089/jca.2018.12.007 |
| 中文关键词: 超声引导 竖脊肌平面阻滞 腰椎后路手术 术后镇痛 |
| 英文关键词: Ultrasound-guided Erector spinae plane block Lumbar posterior surgery Postoperative analgesia |
| 基金项目:泸州市科技创新苗子培育计划［2013-R-52(13/18)］ |
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| 中文摘要: |
目的 探讨超声引导下竖脊肌平面(erector spine plane, ESP)阻滞在腰椎后路手术中的应用效果。
方法 选择全麻下行腰椎两个节段以内手术的患者60例,男29例,女31例,年龄18～70岁,BMI 20～27 kg/m2,ASA Ⅰ或Ⅱ级,随机分为两组:ESP阻滞联合PCIA组 (EP组) 和PCIA组 (P组)。两组均采用静-吸复合麻醉,术毕均使用PCIA,EP组在麻醉诱导前于俯卧位下行ESP阻滞。记录术中血流动力学不稳定次数;记录阿片类药物和肌松药使用量；记录术后48 h以内按压次数和补救性镇痛给药次数;记录住院时间、首次下床活动时间、首次排气时间;记录术后48 h以内恶心呕吐等不良反应发生情况。
结果 EP组术中血流动力学不稳定次数明显少于P组(P<0.05);EP组的瑞芬太尼用量、顺式阿曲库铵维持剂量、顺式阿曲库铵使用总量均明显少于P组(P<0.01);EP组按压次数和补救性镇痛帕瑞昔布钠给药次数明显少于P组(P<0.05);EP组住院时间、术后首次下床活动时间、首次排气时间明显短于P组(P<0.05);两组术后不良反应发生率差异无统计学意义。
结论 全麻复合超声引导下竖脊肌平面阻滞可以维持腰椎后路手术更平稳,有利于术后早期恢复。 |
| 英文摘要: |
Objective To investigate the efficiency of ultrasound-guided erector spinae plane (ESP) block as an adjuvant to general anesthesia and postoperative analgesia in lumbar posterior lumbar surgery.
Methods Sixty patients， 29 males and 31 females, aged 18 - 70 years, BMI 20 - 27 kg/m2, falling into ASA physical status Ⅰ or Ⅱ, undergoing two intraoperative lumbar vertebrae with general anesthesia, were randomized into ESP block combined with PCIA group (group EP) and PCIA group (group P). Patients in the group EP received ultrasound-guided ESP block in prone position before general anesthesia whereas those in group P received only general anesthesia. All patients received PCIA after operations. The frequency of unstable hemodynamics, opioid dosage, muscle relaxant dosage were recorded. The frequency of PCIA compressions, rescue analgesic administrations, the length of hospital stay, the time of getting out of bed for exercise and activity,the flatus time, and postoperative complications were recored.
Results The frequency of unstable hemodynamics in group EP was less than group P (P<0.05). The maintenance dosage of remifentanil and cis-atracurium were lower in group EP than in group P, the total amount of cis-atracurium as lower as well (P<0.01). The frequency of PCIA compressions and the administration of parecoxib sodium were notably less than that of group P (P<0.05), the time of postoperative activity and flatus in group EP were earlier than group P (P<0.05), the duration of hospital stay in group EP was less than group P (P<0.05). There was no significant difference in the incidence of nausea and vomiting between the two groups.
Conclusion General anesthesia combined with ultrasound-guided erector spinae block can keep vital signs stable in lumbar posterior surgery, and can be benefit for earlier activity after surgery. |
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