不同麻醉下椎间孔镜治疗腰椎间盘突出症疗效观察

Curative effects of percutaneous transforaminal endoscopic discectomy on lumbar disc herniation treatment in different anesthesia

目的对比分析局麻与连续硬膜外麻醉下行经皮椎间孔镜治疗腰椎间盘突症的临床治疗效果。方法选择2010年1月至2012年12月行经皮椎间孔镜下突出椎间盘切除术(PTED)患者共36例,根据患者对麻醉的选择分为A、B两组,A组18例选择局麻、B组18例选择连续硬膜外麻醉;术前、术后行患者疗效满意情况评价即ODI及VAS评分,术中疼痛感受分:无疼痛、轻度疼痛、中度疼痛、重度疼痛,无疼痛及轻度疼痛为麻醉满意,中、重度疼痛为麻醉不满意。结果 A组中2例因术中不能耐受疼痛而改硬膜外麻醉,两组病例术后均无发生脑脊液漏、神经根损伤等并发症;两组患者术中发生疼痛满意度比较差异有统计学意义(P<0.05);两组术后3个月ODI评分及VAS疼痛评分较术前明显缓解(P<0.05);A、B两组术前、术后3月ODI评分与术前、术后3个月VAS评分比较差异无统计学意义(P>0.05)。结论对于选择何种麻醉下完成PTED,与术者的技术熟练程度、临床操作经验及应变处理能力密切相关。但选择连续硬膜外麻醉,可避免或减少患者术中疼痛等不适情况。

Objective To investigate the effects of percutaneous transforaminal endoscopic discectomy （PTED） on lumbar disc herniation treatment via local anesthesia and continuous epidural anesthesi. Methods From Janu- ary, 2010 to December, 2012, a total of 36 patients with PTED operation was selected. Patients were divided in- to A with 18 cases via local anesthesia and B with 18 cases via continuous epidural anesthesia groups. All cases received intervertebral foramen and fiber loop mirror disc herniation of nucleus pulposus enucleation plasty under the prone position. The preoperative and postoperative patients were evaluated with satisfactory curative efficacy including Oswestry disability Index （ODI） and VAS scores. Intraoperative pain perception index included no pain, light pain, moderate pain and severe pain. No pain and light pain were considered as anesthesia satisfac- tion and moderate pain and severe pain were identified for anesthesia disatisfaction. Results In operation, two ca- ses in group A could not tolerate the pain and changed to epidural anesthesia to complete the operation. After op- eration, no cerebrospinal fluid leakage and nerve root injury and other complications occurred in two groups. The significant difference of intraoperative pain and discomfort between the two groups was shown （ P 〈 0.05 ）. Three months after surgery, ODI score and VAS score of pain in two groups were attenuated obviously than those before surgery （P 〈 0.05）. However, before surgery, three months after surgery, no significant difference of ODI score and VAS score in two groups was detected （ P 〉 0.05 ）. Conclusion The successful PTED operation under differ- ent anesthesia is closely related to the technical proficiency, clinical experience and operationer＇ s strain capaci- ty. The continuous epidural anesthesia could be used to avoid or reduce the patient pain and discomfort.