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| 双侧头颈半棘肌间平面阻滞对颈椎后路手术患者术后恢复质量的影响 |
| Effect of a bilateral inter-semipinal plane block on quality of recovery in patients undergoing posterior cervical surgery |
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| DOI：10.12089/jca.2023.12.002 |
| 中文关键词: 半棘肌间平面阻滞 颈椎后路手术 恢复质量 |
| 英文关键词: Inter-semispinal plane bock Posterior cervical surgery Quality of recovery |
| 基金项目:江西省教育厅科学技术项目（GJJ2200207） |
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| 中文摘要: |
目的 探讨头颈半棘肌间平面阻滞（ISPB）对颈椎后路手术患者术后恢复质量的影响。
方法 选择2023年1—4月择期行颈椎后路手术的患者72例，男41例，女31例，年龄18～64岁，BMI 18～28 kg/m2，ASA Ⅱ或Ⅲ级。采用随机区组设计将患者分为两组：ISPB组（I组）和对照组（C组），每组36例。所有患者在麻醉诱导前使用超声定位于C5平面，I组在双侧头半棘肌和颈半棘肌之间筋膜平面内注射0.25%罗哌卡因20 ml，C组注射同等体积生理盐水，注射完成后15 min开始麻醉诱导。记录术前1 d、术后1、2 d 40项恢复质量评分（QoR-40）、匹兹堡睡眠质量指数（PSQI）。记录术后1、6、12、24、48 h NRS评分。记录PCIA有效按压次数、PCIA总按压次数、补救镇痛例数，术中舒芬太尼、瑞芬太尼用量和术后喷他佐辛用量。记录术后恶心呕吐（PONV）的发生情况、术后首次独立下地行走时间和首次经口进食时间、血肿、感染或局麻药中毒等穿刺相关并发症的发生情况。
结果 与术前1 d比较，两组术后1、2 d QoR-40各项评分和总分明显降低，PSQI明显升高（P<0.05）。与C组比较，I组术后1、2 d QoR-40情绪状态、身体舒适度、心理支持、疼痛评分和总分均明显升高，PSQI明显降低（P<0.05）；术后1、6、12、24 h NRS评分均明显降低（P<0.05）；术后PICA有效按压次数、PCIA总按压次数、补救镇痛率、术中瑞芬太尼用量、术后喷他佐辛用量、PONV发生率均明显降低，术后首次独立下地行走时间和首次经口进食时间明显缩短（P<0.05）。两组无一例发生穿刺相关并发症。
结论 双侧ISPB可有效改善颈椎后路手术患者术后睡眠，减轻术后疼痛，降低PONV发生率，提高患者术后恢复质量。 |
| 英文摘要: |
Objective To determine how inter-semispinal plane block (ISPB) affects how well individuals recover after having posterior cervical surgery.
Methods Seventy-two patients chosen for elective posterior cervical surgery from January to April 2023, 41 males and 31 females, aged 18-64, BMI 18-28 kg/m2, ASA physical status Ⅱ or Ⅲ, were divided into two groups using randomized block design: the ISPB group (group I) and the control group (group C), 36 patients in each group. Before anesthesia induction, all patients were positioned at the 5th cervical vertebra plane using ultrasound, and 0.25% ropivacaine 20 ml or the same volume of physiological saline were injected into the fascia plane between the bilateral semispinalis cervicis and semispinalis capitis muscles. Anesthetic induction began 15 minutes after injection. QoR-40 and Pittsburgh sleep quality index (PSQI) were recorded 1 day before surgery, 1 day and 2 days after surgery, and pain numerical scores (NRS) were recorded 1, 6, 12, 24, and 48 hours after surgery. The number of effective PCIA compressions, the total number of PCIA compressions, the number of relief analgesia, the dosage of sufentanil, remifentanil intraoperatively and postoperatively, and dosage of pentazocine postoperatively were recorded. The occurrence of postoperative nausea and vomiting (PONV), the time of first independent walking and oral feeding after surgery, and puncture related complications, such as hematoma, infection, and local anesthetic poisoning were recorded.
Results Compared with 1 day before surgery, the total QoR-40 scores and various dimensional scores in the two groups were significantly decreased, while PSQI were significantly increased 1 day and 2 days after surgery (P < 0.05). Compared with group C, the total QoR-40 scores and various dimensional scores except self-care capacity were significantly increased, while PSQI were significantly decreased 1 day and 2 days after surgery (P < 0.05), NRS were significantly decreased 1, 6, 12, and 24 hours after surgery (P < 0.05), the number of effective PCIA compressions, the total number of PCIA compressions, the number of relief analgesia, the dosage of remifentanil intraoperatively, the dosage of pentazocine postoperatively and the occurrence of PONV were significantly decreased (P < 0.05), the time of first independent walking and oral feeding after surgery were significantly shortened in group I (P < 0.05). There were no puncture related complications occurred in the two groups.
Conclusion Bilateral ISPB can effectively improve the postoperative sleep of patients undergoing posterior cervical surgery, reduce postoperative pain and the incidence of PONV, and improve the postoperative recovery quality． |
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