摘要
目的 探讨超声引导下行竖脊肌平面阻滞对椎间孔镜手术患者镇痛效果及应激反应的影响。方法 选取2021年6月至2022年12月于河南省直第三人民医院接受椎间孔镜手术治疗的86例患者作为研究对象,按照随机数字表法分为观察组(接受超声引导下行竖脊肌平面阻滞)与对照组(接受局部浸润麻醉),各43例。对比术前即刻(T_(1))、术后即刻(T_(2))、术后12 h(T_(3))、术后24 h(T_(4))平均动脉压(MAP)、心率(HR)、视觉模拟疼痛评分(VAS)、促肾上腺皮质激素(ACTH)、皮质醇(Cor)及术后24 h内静脉自控镇痛(PCIA)舒芬太尼用量、PCIA按压次数及首次按压PCIA时间。结果 两组MAP、HR、VAS评分、ACTH、Cor的时间效应、组间效应及交互效应有统计学意义(P<0.05)。T_(1)时点两组MAP、HR比较差异无统计学意义(P>0.05),T_(2)、T_(3)、T_(4)时点观察组MAP、HR均低于对照组(P<0.05)。观察组术后VAS评分均低于对照组(P<0.05)。术前,两组ACTH、Cor比较差异无统计学意义(P>0.05),术后第1、3天,观察组ACTH、Cor均低于对照组(P<0.05)。术后24 h内PCIA舒芬太尼用量、PCIA按压次数低于对照组,而首次按压PCIA时间长于对照组(P<0.05)。结论 超声引导下行竖脊肌平面阻滞在椎间孔镜手术中有利于提高镇痛效果,改善血流动力学,减轻应激反应,进一步减少24 h内PCIA舒芬太尼用量与按压次数,延长首次按压PCIA时间。
Objective To investigate the effect of ultrasound-guided descending erector spinal muscle plane block on the analgesic effect and stress response in patients undergoing foraminal mirror surgery.Methods A total of 86 patients undergoing foraminal surgery in Henan Provincial Third People’s Hospital from June 2021 to December 2022 were selected as study subjects,and divided into observation group(accepted ultrasound-guided erector spinal muscle plane block)and control group(accepted local infiltration anesthesia),with 43 cases in each group.Mean arterial pressure(MAP),heart rate(HR),visual analog pain score(VAS),adrenal cortex hormone(ACTH),cortisol(Cor)at immediate preoperative(T_(1)),immediate postoperative(T_(2)),12 hours after surgery(T_(3)),24 hours after surgery(T_(4)),patient controlled intravenous analgesia(PCIA)sufentanil dose in 24 hours,number of PCIA presses in 24 hours and time of PCIA during the first time were compared.Results Time effects,inter-group effects and interaction effects of MAP,HR,VAS score,ACTH and Cor was statistically significant(P<0.05).At time point T_(1),there was no statistically significant difference in MAP and HR between the two groups(P>0.05).At time points T_(2),T_(3) and T_(4),the MAP and HR of the observation group were lower than those of the control group(P<0.05).The postoperative VAS score of the observation group was lower than that of the control group(P<0.05).Before surgery,there was no statistically significant difference in ACTH and Cor between the two groups(P>0.05).On the 1st and 3rd day after surgery,ACTH and Cor in the observation group were lower than those in the control group(P<0.05).Within 24 hours after surgery,the dosage of PCIA sufentanil and the number of PCIA compressions were lower than those in the control group,while the first PCIA compression time was longer than that in the control group(P<0.05).Conclusion Ultrasound-guided descending erector spinal muscle plane block in foraminal mirror surgery is beneficial to improve the analgesic effect,improve hemodynamics,reduce the stress response,further reduce the amount of PCIA sufentanil dosage and the number of presses within 24 hours,and prolong the time of first press PCIA.
作者
马改改
郭晓辉
赵丽青
MA Gaigai;GUO Xiaohui;ZHAO Liqing(Anesthesiology Department,Henan Provincial Third People’s Hospital,Zhengzhou 450000,China)
出处
《河南医学研究》
CAS
2023年第20期3720-3723,共4页
Henan Medical Research
关键词
超声引导
竖脊肌平面阻滞
椎间孔镜手术
镇痛效果
应激反应
ultrasound guidance
plane block of vertical spinal muscles
foraminal mirror surgery
analgesic effect
stress response
