胸腰筋膜间平面阻滞联合自控静脉镇痛对术后认知的影响

Effect of Thoracolumbar Interfascial Block Combined with Controlled Intravenous Analgesia on Postoperative Cognition

目的研究胸腰筋膜间平面阻滞(TLIPB)联合自控静脉镇痛(PCIA)对术后认知的影响。方法选取我院2019年7月至2020年1月的40例择期行后正中入路腰椎融合术(LSF)的老年患者,根据随机数字法将患者分为TP组20例与P组20例,TP组采用TLIPB联合PCIA治疗,P组采用单纯术后PCIA治疗。分别比较两组手术一般指标、不同时间段内的静息与咳嗽视觉模拟评分(VAS)、镇痛泵按压总次数、镇痛药使用剂量、并发症发生率、简易智力量表(MMSE)评分。结果TP组麻醉时间、术中出血量、补液量明显低于P组(P<0.05);TP组静息VAS评分与咳嗽VAS评分均低于P组(P<0.05);TP组镇痛泵按压次数及麻醉使用量明显少于P组(P<0.05);组间比较,治疗前两组MMSE评分比较差异较小(P>0.05);治疗后,TP组MMSE评分均高于P组(P<0.05);组内比较,与治疗前相比,两组治疗后MMSE评分均高于治疗前(P<0.05);P组与TP组并发症发生率分别为50.00%、15.00%(P<0.05)。结论TLIPB联合PCIA能够提高镇痛效果,优化PCIA治疗疗效,降低并发症发生率,值得临床上进一步推广。

Objective To compare the effects of TLIPB combined with PCIA on postoperative cognition.Methods 4 A total of 40 elderly patients undergoing elective posterior median approach lumbar fusion(LSF)in our hospital from July 2019 to January 2020 were selected.According to random number method,the patients were divided into TP group(n=20)and P group(n=20).TLIPB combined with PCIA was used in TP group,while PCIA alone was used in P group.General surgical indicators,visual analogue scale(VAS)for resting and coughing,total number of analgesic pump compressions,dosage of analgesics,incidence of complications,and MMSE scores were compared between the two groups.Results The anesthesia time,intraoperative blood loss and fluid replacement amount in TP group were significantly lower than those in P group(P<0.05).The rest VAS score and cough VAS score in TP group were lower than those in P group(P<0.05).The Times of analgesia pump pressure and the amount of anesthesia in TP group were significantly lower than those in P group(P<0.05).There was little difference in MMSE scores between the two groups before treatment(P>0.05).After treatment,MMSE score of TP group was higher than that of P group(P<0.05).Compared with those before treatment,MMSE scores of both groups were higher after treatment(P<0.05).The complication rates of P group and TP group were 50.00%and 15.00%,respectively(P<0.05).Conclusion TLIPB combined with PCIA can improve the analgesic effect,optimize the therapeutic effect of PCIA,and reduce the incidence of complications,which is worthy of further promotion in clinical practice.