超声引导下竖脊肌平面阻滞对腰椎减压融合内固定手术镇痛及术后恢复的影响

Effect of ultrasound-guided erector spinal plane block on analgesia and postoperative recovery of lumbar spine decompression and fusion internal fixation operation

目的探讨超声引导下竖脊肌平面阻滞(ESPB)在腰椎减压融合内固定术中的应用效果。方法选取2018年11月至2019年10月在该院行腰椎减压融合内固定术的患者56例,按随机数字表法分为两组,各28例。研究组实施ESPB干预下全身麻醉插管,对照组实施全身麻醉插管,记录术中生命体征、麻醉药使用总量、手术节段、手术时间、麻醉时间、手术者对肌肉松弛的满意度及患者对镇痛的满意度;术后不同时段静息时切口视觉模拟评分(VAS)、48 h内自控静脉镇痛(PICA)按压和补救镇痛药物使用比例、不良反应及术后恢复相关指标。结果两组患者术中生命体征、术中情况、术后24、48 h静息切口VAS、术后48 h不良反应发生率无明显差异(P>0.05)。与对照组比较,研究组术中丙泊酚、舒芬太尼、瑞芬太尼、苯磺顺阿曲库铵用量明显减少(P<0.05),手术者对手术区域肌肉松弛满意度较高(P<0.05),术后48 h患者对镇痛的满意度较高(P<0.05),术后4、8 h静息切口VAS降低(P<0.05),术后48 h内补救镇痛药物使用和PICA按压患者比例均降低(P<0.01),住院时间明显缩短,首次下床活动时间、首次排气时间明显提前(P<0.05)。结论超声引导下ESPB可有效提高减压融合内固定术患者术后镇痛的效果,有利于术后早期恢复。

Objective To explore the application effect of ultrasound-guided erector spinal muscle plane block(ESPB)in lumbar decompression and fusion internal fixation.Methods Fifty-six patients with lumbar decompression and fusion internal fixation in this hospital from November 2018 to October 2019 were selected and divided into the two groups according to the random number table method,28 cases in each group.The study group implemented the general anesthesia intubation under the ESPB intervention and the control group conducted the general anesthesia intubation.The intraoperative vital signs,total amount of anesthetic drugs use,operation segment,operation time,anesthesia time,surgeon′s satisfaction on muscular relaxation and patient′s satisfaction on analgesia were recorded.The VAS scores at different postoperative time periods,patient controlled intravenous analgesia(PCIA)press and the proportion of remedial analgesic medication use within postoperative 48 h,adverse reactions and postoperative recovery indexes were recorded.Results There was no statistical difference in the vital signs,intraoperative situation,VAS scores of the resting incision at postoperative 24,48 h and occurrence rate of adverse reactions at postoperative 48 h between the two groups(P>0.05).Compared with the control group,the use amounts of intraoperative propofol,sufentanil,remifentanil and cisatracurium in the study group were significant decreased(P<0.05).The surgeon′s satisfaction on muscle relaxation of the operation area in the study group was higher(P<0.05);the satisfaction degree of the patients on analgesia at postoperative 48 h was higher(P<0.05);the VAS scores of the resting incision at postoperative 4,8 h were reduced(P<0.055);the proportion of remedial analgesic drugs use and the patients with PICA press at postoperative 48 h were reduced(P<0.01);the length of hospital stay was shortened;the time of getting out of bed for exercise and activity,the first exhausting time was significantly advanced(P<0.05).Conclusion Ultrasound-guided ESPB can effectively improve the analgesia efficacy for the patients with lumbar decompression fusion and internal fixation,which is conducive to postoperative earlier recovery.