全麻下经皮内镜腰椎间盘切除术的优势

Advantages of general anesthesia used for percutaneous endoscopic lumbar discectomy

[目的]评价全麻下经皮内镜下腰椎间盘髓核摘除术(PELD)的优势。[方法]2018年6月~2019年6月,共75例拟行PELD的患者纳入本研究,依据医患沟通分为两组。其中,39例采用全麻下PELD,36例采用局麻下PELD。比较两组麻醉效果、满意度、焦虑状态、不良反应等指标。[结果]两组患者均顺利完成手术,术中无血管、神经损伤等严重并发症。全麻组手术时间长于局麻组,但差异无统计学意义(P>0.05);全麻组麻醉效果、BAI量表焦虑状况评定、Likert 5点量表麻醉满意度均显著优于局麻组(P<0.05);总不良反应率全麻组为7.69%,局麻组为27.78%。随访6个月以上,随时间推移,两组患者VAS和ODI评分显著减少(P<0.05),相应时间点,两组间VAS和ODI评分的差异均无统计学意义(P>0.05)。[结论]与局麻相比较,全麻下PELD具有提高患者手术舒适度,减少焦虑与恐惧,减少不良反应发生率的显著优势。

[Objective]To evaluate the advantage of general anesthesia used for percutaneous endoscopic lumbar discectomy(PELD).[Methods]From June 2018 to June 2019,a total of 75 patients who were undergoing PELD for lumbar intervertebral disc herniation were included in this study,and divided into two groups based on the sequels of patient-doctor communication.Of them,39 patients had PELD performed under general anesthesia(the GA group),while the remaining 36 patients received PELD with local anesthesia(the LA group).The documents related to anesthetic efficiency,patient’s satisfaction to anesthesia,anxiety state,adverse reactions and so on were compared between the two groups.[Results]All the patients in both groups had PELD finished smoothly without serious complications,such as iatrogenic injury to blood vessels and nerves.Although the GA group consumed longer operation time than the LA group,which was not statistically significant(P>0.05),the GA group proved significantly superior to the LA group regarding to anesthetic efficiency grades,patient’s satisfaction to anesthesia using 5 point Likert scale and anxiety state marked by BAI scale(P<0.05).In addition,the total rate of adverse reaction was of 7.69%in the GA,whereas 27.78%in the LA group,which proved of statistical significance(P<0.05).As time went during the follow-up lasted for more than 6 months,both the VAS and ODI scores significantly decreased(P<0.05).However,no statistical differences between the two groups in the VAS and ODI scores were found at any matching time point(P>0.05).[Conclusion]The general anesthesia used for percutaneous endoscopic lumbar discectomy takes advantages of improving patient’s comfort during operation,lessening anxiety and fear and reducing adverse reactions over the local anesthesia.