摘要
目的:探讨经椎板间入路椎间孔镜下腰椎髓核摘除术中两种温度灌洗液对患者体温、炎性细胞因子水平以及出血量的影响。方法:采用回顾性分析方法,选取2018年1月至2020年12月收治的行椎板间入路经皮椎间孔镜手术患者80例,根据术中灌洗液的温度分为试验组(40例)和对照组(40例)。其中试验组男19例,女21例;年龄(38.8±9.8)岁;L_(4,5)7例,L_(5)S_(1)33例;身体质量指数(body mass index,BMI)(27.8±7.2)kg·m^(-2);使用加温至37℃的生理盐水为灌洗液。对照组男18例,女22例;年龄(41.5±10.9)岁;L_(4,5)5例,L_(5)S_(1)35例;BMI(26.4±6.2)kg·m^(-2);使用室温20~22℃生理盐水作为灌洗液。从镜下操作开始后每间隔10 min记录患者体温,观察术中并发症;记录术前和术后2 h肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-6(interleukin-6,IL-6)和白细胞介素-10(interleukin-10,IL-10)水平;采用视觉模拟评分法(visual analogue scale,VAS)评估两组患者术前和术后2 h腰部疼痛程度;记录两组患者术前和术后2 h纤溶-凝血指标,包括D-二聚体(D-dimer,DD)、纤维蛋白原降解产物(fibrinogen degradation products,FDP)、活化部分凝血活酶时间(activated partial thrombin time,APTT)和凝血酶原时间(prothrombin time,PT);记录两组患者手术时间和出血量。结果:所有患者术中体温呈下降趋势,对照组体温低于试验组。试验组共12例不良反应事件,对照组共22例不良反应事件,组间差异有统计学意义(P<0.05)。两组患者术后2 h血TNF-α,IL-6和IL-10水平均较术前升高(P<0.05),试验组升高水平均低于对照组(P<0.05)。试验组术后腰痛VAS小于对照组(P<0.05)。两组患者术后2 h D-dimer和FDP水平均较术前均升高(P<0.05),试验组低于对照组(P<0.05)。两组患者术后APTT与PT水平较术前差异无统计学意义(P>0.05)。出血量试验组(45.2±14.1)ml,对照组(59.5±15.6)ml,试验组少于对照组(P<0.05)。手术时间试验组(46.7±13.8)min,小于对照组的(58.3±15.2)min(P<0.05)。结论:较传统室温灌洗液,等体温灌洗液能减少椎间孔镜术中不良反应发生率,减轻局部炎症反应,减少术中出血量并缩短手术时间。
Objective To investigate the effects of two types of temperature rinses on body temperature,inflammatory cytokine levels,and bleeding volume in percutaneous endoscopic lumbar discectomy.Methods Eighty patients underwent percutaneous endoscopic lumbar discectomy from January 2018 to December 2020 were selected and divided into experimental group(40 cases)and control group(40 cases).In experimental group,there were 19 males and 21 females,aged(38.8±9.8)years old;7patients on L_(4,5) and 33 patients on L_(5)S_(1);Body msss index(BMI)was(27.8±7.2)kg·m^(-2).In contral group,there were 18 males and 22 females,aged(41.5±10.9)years old,5 patients on L_(4,5) and 35 patients on L_(5)S_(1);BMI was(26.4±6.2)kg·m^(-2).The patients in the control group were received normal saline rinse at room temperature,and the patients in the experimental group were received normal saline rinse heated to 37℃.Body temperature,chills,nausea,vomiting,and other adverse reactions were recorded.The levels of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and interleukin-10(IL-10)in two groups were recorded before and 2 hours after operation.Visual analogue scale(VAS)was used to evaluate the degree of lumbar pain in two groups before and 2 hours after surgery.Fibrinolytic-coagulation indexes with preoperative and 2 hours aftersurgery,including the D-dimer(DD),fibrinogen degradation products(FDP),activated partial thrombin time(APTT)and prothrombin time(PT)were recorder.Operation time and blood loss in two groups were recorded.Results The body temperature of both groups showed a downward trend,while the body temperature of the control group was lower than that of the experimental group.The levels of TNF-α,IL-6 and IL-10 in two groups were increased 2 hours after surgery compared with those before surgery(P<0.05),while the levels in experimental group were lower than those in control group(P<0.05).Postoperative VAS in experimental group 2.19±1.13 was significantly lower than that in the control group 3.38±1.35(P<0.05).The levels of DD and FDP at 2 hours after surgery in both groups were higher than those before surgery(P<0.05),while the levels of DD and FDP in the experimental group were higher than those in the control group(P<0.05).There was no significant difference in APTT and PT levels between two groups after operation(P>0.05).The blood loss in the experimental group of(45.2±14.1)ml was lower than that in the control group of(59.52±15.6)ml.The operation time of experimental group(46.7±13.8)min was less than that of control group(58.3±15.2)min(P<0.05).Conclusion Body temperature rinse can reduce the incidence of adverse reactions,alleviate local inflammatory reactions,reduce intraoperative blood loss and shorten the operation time.
作者
张立栋
张成亮
宋大江
陈刚
庄严雷
ZHANG Li-dong;ZHANG Cheng-liang;SONG Da-jiang;CHEN Gang;ZHUANG Yan-lei(Department of Orthopaedics,Shuyang Hospital,Shuyang 223600,Jiangsu,China)
出处
《中国骨伤》
CAS
CSCD
2023年第9期854-858,共5页
China Journal of Orthopaedics and Traumatology
基金
宿迁市指导性课题(编号:Z2021002)。
关键词
腰椎
外科手术
椎间孔镜手术
灌洗液温度
Lumbar vertebrae
Surgical procedures,operative
Intervertebral transforaminal endoscopic surgery
Lavage fluid temperature
