硬膜外麻醉在椎间孔手术中的应用

Application of epidural anesthesia in intervertebral foramen surgery

目的:比较低浓度局麻药的硬膜外麻醉(EA)与局麻(GA)下行经皮椎间孔镜治疗腰椎间盘突症(PTED)的麻醉效果。方法:收治PTED患者30例,平分为EA组和GA组,比较患者术中生命体征的变化、疼痛程度和阿片类药的用量。结果:GA组术中患者疼痛剧烈常需静脉注射阿片类药减轻痛苦,因术中不能耐受疼痛而改全身麻醉下行开放手术1例,EA组选择低浓度小剂量局麻药,镇痛完善,术中疼痛不适程度轻,阿片类药用量少,两组病例术后均无并发症发生,两组术中血氧饱和度比较,差异有统计学意义(P<0.05),两组术中疼痛程度和阿片类药的用量比较,差异有统计学意义(P<0.01)。结论:选择低浓度局麻药的硬膜外麻醉在椎间孔镜微创手术中的麻醉效果优于局麻。

Objective:To compare the anesthetic effect of low concentrations of local anesthetics epidural anesthesia(EA)and local anesthesia(GA) in the treatment of patients with percutaneous endoscopic lumbar discectomy.Methods:30 patients with percutaneous endoscopic lumbar discectomy were selected.They were divided into the EA group and the GA group on average.We compared the changes of vital signs,the degree of pain and the dosage of opioids in patients during operation.Results:Patients in the GA group with severe pain during surgery,intravenous opioids were often required to relieve pain;1 case turned to open surgery under general anesthesia due to could not tolerant the pain during surgery;low dose of local anesthetics were selected in the EA group;the analgesia was perfect.During the operation,the pain was mild,and the dosage of opioids was low.No complications occurred in the two groups after operation.There was significant difference in blood oxygen saturation during surgery between the two groups(P<0.05),and there was a significant difference between the two groups in the degree of pain and the dosage of opioids(P<0.01).Conclusion:The anesthesia effect of low concentration of local anesthetic epidural anesthesia is better than general anesthesia in PTED minimally invasive surgery.