经皮椎体成形术治疗骨质疏松性椎体压缩性骨折术中采用椎旁神经阻滞的镇痛效果

Analgesic effect of paravertebral block in percutaneous vertebroplasty for osteoporotic vertebral compression fracture

目的探讨经皮椎体成形术(PVP)治疗骨质疏松性椎体压缩性骨折(OVCF)术中采用椎旁神经阻滞的镇痛效果。方法2020年1月-2020年8月,华侨大学附属德化医院采用PVP治疗OVCF患者60例,其中30例采用椎旁神经阻滞麻醉(神经阻滞组),30例采用传统局部麻醉(局部麻醉组)。比较2组手术时间、住院时间、住院总费用、术中平均动脉压和心率变化,及手术前后疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)。结果2组手术时间、住院时间、住院总费用差异均无统计学意义(P>0.05)。神经阻滞组患者术中各时间点的平均动脉压、心率与术前比较,差异无统计学意义(P>0.05);局部麻醉组患者术中各时间点的平均动脉压、心率均较术前升高,差异有统计学意义(P<0.05)。2组术后VAS评分、ODI均较术前明显降低,差异有统计学意义(P<0.05);神经阻滞组术中、术后1 d、术后1个月VAS评分低于局部麻醉组,差异有统计学意义(P<0.05);神经阻滞组术后1 d、术后1个月ODI低于局部麻醉组,差异有统计学意义(P<0.05);2组术后3个月VAS评分、ODI差异无统计学意义(P>0.05)。结论PVP治疗OVCF术中采用椎旁神经阻滞麻醉并未增加风险、手术时间及住院费用,术中血流动力学相对稳定,且可有效缓解患者术中、术后早期疼痛,值得临床推广应用。

Objective To investigate the analgesic effect of paravertebral block in percutaneous vertebroplasty(PVP)for the treatment of osteoportic vertebral compression fracture(OVCF).Methods From January 2020 to August 2020,60 OVCF patients were treated by PVP in Dehua Hospital of Huaqiao University.Among them,30 patients were treated with paravertebral block anesthesia(block group)and 30 with traditional local anesthesia(local group).The operation time,hospital stay,hospitalization cost,intraoperative mean arterial pressure(MAP)and heart rate(HR),pre-and post-operative visual analogue scale(VAS)score and Oswestry disability index(ODI)were compared between the 2 groups.Results There was no significant difference in operation time,hospital stay and hospitalization cost between the 2 groups(P>0.05).In the block group,there was no significant difference in intraoperative MAP and HR at each time point compared with those at pre-operation(P>0.05).In the local group,the MAP and HR were higher than those at pre-operation,and the differences were statistically significant(P<0.05).The VAS score and ODI of the 2 groups were significantly reduced compared with those at pre-operation,all with a statistical difference(P<0.05).The VAS scores at intra-operation,postoperative 1 d and postoperative 1 month in the block group were significantly lower than those in the local group(P<0.05).The ODI at postoperative 1 d and postoperative 1 month in the block group were significantly lower than those in the local group(P<0.05).There was no significant difference in VAS score and ODI at postoperative 3 months between the 2 groups(P>0.05).Conclusion PVP in the treatment of OVCF with paravertebral block anesthesia does not increase the risk,operation time or hospitalization cost,and intraoperative hemodynamics is relatively stable,and can effectively relieve the patients'intraoperative and early postoperative pain,which is worthy of clinical application.