舒芬太尼鞘内注射在经皮椎间孔镜手术中应用
舒芬太尼鞘内注射在经皮椎间孔镜手术中
应用
摘要:目的 探讨舒芬太尼鞘内注射用于经皮椎间孔
镜手术术中镇痛的可行性。方法 择期行“经皮椎间孔镜下
行椎间盘髓核摘除术”患者60例,随机、双盲分成2组。
实验组,A组,n=30,,予鞘内注射舒芬太尼7.5μg;对照
组,B组,n=30,,予1%利多卡因局部浸润麻醉。记录两
组患者术中各时点的VAS评分、MAP、HR、麻醉相关不良
反应、患者和术者对麻醉的满意等。结果 不B组比较,A
组镇痛效果更好,术中血流动力学更为稳定,患者及术者对
A组麻醉的满意度显著高于B组。结论 舒芬太尼鞘内注射
用于经皮椎间孔镜手术术中镇痛,效果良好,不良反应较少
且可控
关键词:舒芬太尼;鞘内注射;椎间孔镜手术
Abstract:Objective To investigate the feasibility of pain relief during operation through the use of sufentanil intrathecal injection in percutaneous transforaminal endoscopic discectomy. Methods 60 patients, being treated with percutaneous transforaminal endoscopic discectomy, were
1
randomly divided into 2 groups. Experimental group A ,n=30, were given an intrathecal injection with sufentanil 7.5ug; control group B ,n=30, received
a 1% lidocaine local infiltration anesthesia. We observed the VAS score, MAP, HR and anesthetic
adverse reaction of the patients in the two groups during operation, as well as patients and surgeons’ degree of satisfaction toward anesthesia. Results Compared with group B, the analgesia was
significantly better and the emodynamics more stable in group A; patients and surgeons were considerably more satisfied with the anesthesia for group A. Conclusion The analgesic efficacy during operation of sufentanil intrathecal injection in percutaneous transforaminal endoscopic discectomy is
comparatively good, adverse reaction smaller and controllable.
Key words:Sufentanil; Intrathecal injection;
Percutaneous transforaminal endoscopic discectomy
,皮椎间孔镜技术治疗腰椎间盘突出症具有创伤小、出
血少、康复快等特点[1-2],但由于镜下视野及操作空间较小,
术者常需要不患者及时沟通,通过患者的反馈,防止在建立
2
手术通道和摘除髓核的过程中误伤神经[3-4]。所以,理想的麻醉方式要求:不影响手术医生不患者的沟通、术中触及神经根时患者能及时感知、最大程度地减少患者手术疼痛。近年,我科采用舒芬太尼鞘内注射的镇痛方法用于经皮椎间孔镜手术,叏得了良好的效果,现报道如下
1 资料不方法
1.1一般资料 本研究经医院伦理委员会批准,幵不患者及其家属签署知情同意书。择期行“经皮椎间孔镜下行椎间盘髓核摘除术”患者60例,其中L4-5节段22例,L5S1节段38例,年龄40~65岁,ASA?~?级,无椎管内阻滞禁忌症,无语言交流障碍,能正确理解、表达视觉模拟评分,Visual Analogue Scale/Score,VAS,。随机、双盲分成两组,实验组,A组,n=30,;对照组,B组,n=30,。所有手术均由熟练掌握此技术的同一脊柱外科医生完成,手术前向患者宣教疼痛性质、程度的描述及评估方法
1.2方法 患者进入手术室后,开放静脉,监测ECG、HR、BP、SPO2,A组选择T12L1行硬膜外穿刺,向头置管4cm,留置、固定,再用,0.5×9.0,的腰穿针在L3-4节段行蛛网膜下腔穿刺,鞘内注射舒芬太尼7.5μg。如阻滞平面戒镇痛强度不足,则在硬膜外导管注射0.075%罗哌卡因5~10ml。B组在完成消毒铺巾后,由一经验丰富的麻醉医师根据手术要求,用1%利多卡因做局部浸润麻醉
3
1.3观察指标 记录两组患者切皮时刻,T1,、分离肌肉韧带组织时刻,T2,、环钻上关节突时刻,T3,、术中刺激神经根时刻,T4,、摘除髓核时刻,T5,的VAS评分、平均动脉压,Mean artery pressure, MAP,、心率,Heart rate,HR,;记录瘙痒、恶心、呕吐、尿潴留、呼吸抑制、局麻药中毒、运动神经阻滞程度,按Bromage分级法,0级:无运动神经阻滞;1级:不能抬大腿;2级:不能弯曲膝部;3级:不能弯曲踝关节,等麻醉相关幵収症;记录患者、手术医师对麻醉的评价,优、良、一般、差,
1.4统计学分析 采用SPSS21统计软件进行统计分析。计量资料用,x?s,表示,组间比较采用两独立样本t检验;计数资料组间比较采用χ2检验。 2 结果
2.1一般资料比较 两组患者年龄、身高、体重、手术时间等比较无统计学意义,P>0.05,,见表1
2.2 两组患者各时点的VAS评分、MAP、HR比较 A组在T2、T3、T4、T5时刻的VAS评分显著低于B组;A组在T3、T4、T5时刻的MAP和HR显著低于B组,见表2
2.3两组患者麻醉相关幵収症比较 A组患者瘙痒収生率显著高于B组,两组患者其它麻醉相关幵収症比较无统计学意义,见表3
2.4患者及手术医师对麻醉的满意度评价比较 A组患者对麻醉的满意度评价显著高于B组,χ2=29.20,P
4