低容量多点竖脊肌阻滞在腰椎手术的应用研究

Application of Low Volume Multi-point Erector Spinal Block in Lumbar Surgery

目的:探讨低容量多点腰椎竖脊肌平面阻滞(ESPB)在腰椎手术中的应用价值。方法:60例行腰椎椎间融合术的老年患者随机分为研究组(ESPB联合全身麻醉组)和对照组(全身麻醉组),每组30例。对照组患者行全身麻醉,研究组患者于麻醉诱导后行双侧低容量多点ESPB(0.4%罗哌卡因10 mL/点,共4个阻滞点),术后两组均采用静脉自控镇痛泵。记录术中麻醉药的用量;记录各时段平均动脉压(MAP)、心率(HR);记录术后48 h内数字疼痛评分(NRS)、追加镇痛、补救镇痛次数以及不良反应。结果:⑴研究组七氟醚、舒芬太尼的用量少于对照组(P<0.05);⑵对照组患者在切皮后5 min血流动力学发生明显波动,MAP、HR均高于研究组(P<0.05);⑶在恢复室的NRS评分研究组明显低于对照组(P<0.05),两组患者术后4、24、48 h的NRS评分无明显差异(P>0.05);研究组48 h内镇痛泵追加镇痛以及补救镇痛的次数明显少于对照组(P<0.05);两组患者术后不良反应无明显差异(P>0.05)。结论:低容量多点腰椎ESPB在腰椎手术中的应用可减轻机体应激反应,避免手术刺激引起的血流动力学波动,减少术中镇痛、镇静药用量,可缓解术后急性疼痛,有利于患者快速康复,值得推广应用。

Objective To explore the application value of low volume multipoint lumbar spine plane block(ESPB)in lumbar surgery.Methods 60 elderly patients who underwent lumbar interbody fusion were randomly divided into study group(ESPB combined general anesthesia group)and control group(general anesthesia group),with 30 patients in each group.Patients in the control group were given general anesthesia,and patients in the study group were given bilateral low-volume multi-point ESPB(10 mL 0.4%ropivacaine was injected at each point,a total of 4 blocking points)after induction of anesthesia.After the operation,the two groups were treated with intravenous analgesia pump.The dosage of anesthetics during the operation,the mean arterial pressure(MAP)and heart rate(HR)at perioperative period,the numerical rating scale(NRS),the number of additional analgesia,the number of remedial analgesia,and the adverse reactions within 48 hours after the operation were recorded.Results⑴The dosage of sevoflurane and sufentanil in the study group was less than that in the control group(P<0.05).⑵The hemodynamics of patients in the control group fluctuated significantly 5 min after skin resection,and both MAP and HR were higher than those in the study group(P<0.05).⑶The NRS score in the study group in the recovery room was significantly lower than that in the control group(P<0.05),and there was no statistically significant difference between the two groups in NRS score at 4 h,24 h and 48 h postoperatively(P>0.05).The frequency of additional analgesia and remedial analgesia in the study group was significantly lower than that in the control group within 48 h(P<0.05).There was no statistically significant difference in postoperative adverse reactions between the two groups(P>0.05).Conclusion The application of low-volume multi-point lumbar ESPB in lumbar surgery can reduce the stress response,avoid the fluctuation of hemodynamics caused by the surgical stimulation,reduce the amount of analgesic and sedative drugs during the operation,relieve the acute pain after the operation,and help patients recover quickly,which is worthy of promotion and application.