文章摘要
超声引导下椎板后阻滞在腰椎骨折手术患者中的应用
Application of ultrasound-guided posterior retrolaminal block in patients with lumbar fractures surgery
  
DOI：10.12089/jca.2022.02.006
中文关键词: 超声引导下椎板后阻滞  全身麻醉  腰椎骨折  神经电生理  炎性因子
英文关键词: Ultrasound-guided posterior retrolaminal block  General anesthesia  Lumbar fracture  Neuroelectrophysiology  Inflammatory factors
基金项目:杭州市医药卫生科技项目（B20200155）
作者单位E-mail
李勇 311201,浙江中医药大学附属江南医院,杭州市萧山区中医院麻醉科 635940892@qq.com 
龚星兆 311201,浙江中医药大学附属江南医院,杭州市萧山区中医院麻醉科  
葛梅 311201,浙江中医药大学附属江南医院,杭州市萧山区中医院麻醉科  
侯俊青 311201,浙江中医药大学附属江南医院,杭州市萧山区中医院麻醉科  
钟湘怡 311201,浙江中医药大学附属江南医院,杭州市萧山区中医院麻醉科  
张珏诚 311201,浙江中医药大学附属江南医院,杭州市萧山区中医院麻醉科  
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中文摘要:
      
目的 探讨超声引导下椎板后阻滞在腰椎骨折手术患者中的应用效果。
方法 选择2019年9月至2020年9月腰椎骨折手术的患者92例，男50例，女42例，年龄40~60岁，BMI 20~26 kg/m2，ASA Ⅰ—Ⅲ级。采用随机数字表法将患者分为两组：超声引导下椎板后阻滞组（P组）和单纯全麻组（C组），每组46例。P组于全麻诱导前超声引导下行椎板后阻滞，C组仅行单纯全麻，所有患者全麻用药方案一致。记录麻醉诱导前15 min、术后15 min、12 h、24 h血清可溶性肿瘤坏死因子Ⅰ型受体（sTNF-RI）、前列腺素E2（PGE2）浓度。记录麻醉诱导前15 min、插管后15 min、切皮即刻、切口关闭前即刻神经电生理监测指标体感诱发电位（SSEP）波幅与潜伏期水平。记录术后2、4、12、24 h VAS疼痛评分、镇痛泵有效按压次数、补救镇痛情况、术后首次下床活动时间、术后住院时间、躁动、过敏、呼吸抑制的发生情况。
结果 与麻醉诱导前15 min比较，两组术后15 min、12 h血清sTNF-RI浓度明显降低（P<0.05），PGE2浓度明显升高（P<0.05）；插管后15 min、切皮即刻、切口关闭前即刻N45-P38波幅明显降低（P<0.05），N45潜伏期、P38潜伏期明显延长（P<0.05）。与C组比较，P组术后15 min、12 h血清sTNF-RI浓度明显升高（P<0.05），PGE2浓度明显降低（P<0.05）；插管后15 min、切皮即刻、切口关闭前即刻N45-P38波幅明显升高（P<0.05），N45潜伏期、P38潜伏期明显缩短（P<0.05）；术后2、4、12 h VAS疼痛评分明显降低（P<0.05）；镇痛泵有效按压次数明显减少（P<0.05），补救镇痛率明显降低（P<0.05），术后首次下床活动时间和术后住院时间明显缩短（P<0.05）。两组躁动、过敏、呼吸抑制发生率差异均无统计学意义。
结论 超声引导下椎板后阻滞应用于腰椎骨折手术患者可降低其PGE2浓度、N45-P38波幅和术后VAS疼痛评分，升高sTNF-RI浓度，缩短术后首次下床活动时间和术后住院时间，改善患者预后。
英文摘要:
      
Objective To investigate the effect of ultrasound-guided retrolaminal block in patients with lumbar fracture surgery.
Methods Ninety-two patients with lumbar fractures surgery in our hospital from September 2019 to September 2020 were selected, 50 males and 42 females, aged 40-60 years, BMI 20-26 kg/m2, ASA physical status Ⅰ-Ⅲ. Patients were divided into two groups by random number table method: ultrasound-guided posterior retrolaminal block group (group P) and general anesthesia group (group C), 46 patients in each group. Group P was received ultrasound-guided posterior retroloaminal block before general anesthesia induction, and group C was received general anesthesia only, all patients received the same general anesthesia regimen. The concentrations of serum-related inflammatory factors soluble tumor necrosis factor-I receptor (sTNF-RI) and prostaglandin E2 (PGE2) 15 minutes before anesthesia induction, 15 minutes, 12 hours and 24 hours after operation were recorded. The amplitude and latency of somatosensory evoked potential (SSEP) were recorded 15 minutes before anesthesia induction, 15 minutes after intubation, immediately after skin incision and immediately before incision closure. The VAS scores 2, 4, 12 and 24 hours after operation, the number of effective analgesic pump compressions, the occurrence of resure analgesia, the first ambulation time after operation, hospitalization time after surgery, agitation, allergy, respiratory depression were recorded.
Results Compared with 15 minutes before anesthesia induction, the serum sTNF-RI concentration 15 minutes and 12 hours after operation in the two groups was significantly decreased (P < 0.05), and PGE2 concentration was significantly increased (P < 0.05). The amplitude of N45-P38 was significantly decreased (P < 0.05), and the latency of N45 and P38 was significantly prolonged 15 minutes after intubation, immediately after skin incision and immediately before incision closure (P < 0.05). Compared with group C, serum sTNF-RI concentration in group P 15 minutes and 12 hours after operation was significantly increased (P < 0.05), and PGE2 concentration was significantly decreased (P < 0.05). The amplitude of N45-P38 was significantly increased 15 minutes after intubation， immediately after skin incision and immediately before incision closure (P < 0.05), and the latency of N45 and P38 was significantly shortened (P < 0.05). VAS scores 2, 4 and 12 hours after operation, the number of effective pump compressions, and the incidence of rescue analgesia were significantly decreased (P < 0.05), the first ambulation time and hospitalization time in group P were significantly shortened (P < 0.05). There were no significant differences in the incidences of agitation, allergy, respiratory depression between two groups.
Conclusion Ultrasound-guided posterior retrolaminal block using in patients with lumbar fractures surgery can reduce the concentration of PGE2, the amplitude of N45-P38 and postoperative VAS score, increase the concentration of sTNF-RI, shorten the first ambulation time and hospitalization time after surgery, and improve the prognosis of patients.
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