超声引导下竖脊肌平面阻滞与椎板后阻滞在腰椎手术中的临床应用效果比较

Clinical effect comparison of ultrasound-guided erector spinal muscle plane block and retrolaminar block in lumbar spine surgery

目的探讨超声引导下竖脊肌平面阻滞与椎板后阻滞在腰椎手术中的临床应用效果。方法选取2018年8月~2020年5月大连市中心医院收治的80例腰椎手术患者作为研究对象。按照随机数字表法将其分为两组,每组各40例。观察组患者实施双侧竖脊肌平面阻滞,对照组患者实施椎板后阻滞。比较两组患者手术切皮时的疼痛介质水平;比较两组患者手术切皮时的抗氧化物质及炎症介质水平;比较两组患者术后不同时间点的疼痛数字量表(NRS)评分;比较两组患者的不良反应发生情况。结果手术切皮时,观察组患者的5-羟色胺(5-HT)和P物质(P)水平均低于对照组,差异有统计学意义(P<0.05)。观察组患者手术切皮时的抗氧化物质超氧化物歧化酶(SOD)水平高于对照组,差异有统计学意义(P<0.05)。观察组患者手术切皮时的炎症介质白细胞介素-6(IL-6)水平低于对照组,差异有统计学意义(P<0.05)。观察组术后6、12、24 h的疼痛NRS评分均低于对照组,差异有统计学意义(P<0.05)。观察组患者的不良反应总发生率低于对照组,差异有统计学意义(P<0.05)。结论针对腰椎手术患者,实施竖脊肌平面阻滞,能有效的降低机体疼痛介质释放,缓解疼痛,提高机体抗氧化能力,抑制炎症反应,且治疗安全性高。

Objective To investigate the clinical application effect of ultrasound-guided erector spinal muscle plane block and retrolaminar block in lumbar spine surgery.Methods Eighty cases of lumbar spine surgery patients admitted to Dalian Central Hospital from August 2018 to May 2020 were selected as the research subjects.According to the random number table method,they were divided into two groups,each with 40 cases.In the observation group,bilateral erector spinal muscle plane block was used,and in the control group,retrolaminar block was adopted.The level of pain mediators during surgical skin incisions between the two groups was compared.The levels of antioxidants and inflammatory mediators during surgical skin incisions between the two groups were also compared.The numerical pain scale(NRS)score at different time points after surgery and incidence of adverse reactions were compared between the two groups.Results During surgical skin incision,the levels of 5-hydroxytryptamine(5-HT)and substance P(P)in the observation group were lower than those in the control group,with statistically significant differences(P<0.05).The level of antioxidant substance superoxide dismutase(SOD)in the observation group during surgical skin incision was higher than that of the control group,the difference was statistically significant(P<0.05).The inflammatory mediator interleukin-6(IL-6)level in the observation group during surgical skin incision was lower than that in the control group,the difference was statistically significant(P<0.05).The pain NRS scores of the observation group at 6,12 and 24 h after surgery were lower than those of the control group,and the differences were statistically significant(P<0.05).The total incidence of adverse reactions in observation group was lower than control group,and the difference was statistically significant(P<0.05).Conclusion For patients undergoing lumbar spine surgery,the erector spinal muscle plane block can effectively reduce the body′s pain media release,alleviate pain,improve the body′s antioxidant capacity,and inhibit inflammation in high treatment safety.