罗哌卡因复合芬太尼腰麻与单纯布比卡因腰麻对行经皮椎间孔镜髓核摘除术老年患者麻醉效果和术后镇痛的影响

Effects of Ropivacaine Combined with Fentanyl Spinal Anesthesia and Bupivacaine Spinal Anesthesia on Anesthesia Effect and Postoperative Analgesia of Elderly Patients Undergoing Percutaneous Transforaminal Endoscopic Discectomy

目的:分析罗哌卡因复合芬太尼与单纯布比卡因腰麻对行经皮椎间孔镜髓核摘除术老年患者麻醉效果和术后镇痛的影响。方法:2019年7月至2020年7月于本院实行经皮椎间孔镜髓核摘除术的149例老年患者,按简单随机分组分为对照组(n=74)和观察组(n=75),对照组采用单纯布比卡因腰麻下实施经皮椎间孔镜髓核摘除术,观察组采用罗哌卡因复合芬太尼腰麻下实施经皮椎间孔镜髓核摘除术,比较两组患者麻醉效果、术后镇痛效果、应激反应指标及术后认知功能。结果:观察组麻醉起效时间、麻醉阻滞完善时间及麻醉苏醒时间均快于对照组,差异具有统计学意义(P<0.05);术后4h、12h及24h,观察组术后镇静评分(Ramsay)和面部表情分级评分(FRS)均低于对照组,差异具有统计学意义(P<0.05);观察组心率(HR)、血氧饱和度(SpO2)和平均动脉压(MAP)与麻醉前相比无差异(P<0.05),麻醉后2h和4h数值均高于对照组,差异具有统计学意义(P<0.05);术后7d、14d和28d,观察组蒙特利尔认知评估量表(MoCA)评分显著高于对照组(P<0.05)。结论:罗哌卡因复合芬太尼腰麻下行经皮椎间孔镜髓核摘除术其麻醉效果和术后镇痛效果均好于单纯布比卡因腰麻下进行手术,可有效减少患者术中应激反应,对患者认知功能影响较小,值得临床推广。

Objective:To analyze the effects of ropivacaine combined with fentanyl spinal anesthesia and bupivacaine spinal anesthesia on the anesthesia effect and postoperative analgesia of elderly patients undergoing percutaneous transforaminal endoscopic discectomy.Methods:149 elderly patients who underwent percutaneous transforaminal endoscopic discectomy in this hospital between July 2019 and July 2020 were divided into control group(n=74)and observation group(n=75)with the random number table method.The control group underwent percutaneous transforaminal endoscopic discectomy under spinal anesthesia with pure bupivacaine,and the observation group underwent percutaneous transforaminal endoscopic discectomy under spinal anesthesia with ropivacaine combined with fentanyl.The anesthesia effect,postoperative analgesia effect,stress response indicators and postoperative cognitive function of the two groups were compared.Results:The anesthesia onset time,anesthesia block completion time and anesthesia recovery time of observation group were all faster than those of control group(P<0.05).At 4h,12h and 24h after surgery,the postoperative sedation score(Ramsay)and facial expression grading score(FRS)were lower in observation group than those in control group(P<0.05).There were no statistical differences in the heart rate(HR),blood oxygen saturation(SpO2)and mean arterial pressure(MAP)in observation group compared with those before anesthesia(P<0.05),and the above values at 2h and 4h after anesthesia were higher than those in control group(P<0.05).At 7d,14d and 28d after surgery,the Montreal Cognitive Assessment Scale(MoCA)score of observation group was significantly higher than that of control group(P<0.05).Conclusion:Percutaneous transforaminal endoscopic discectomy under ropivacaine combined with fentanyl spinal anesthesia has better anesthesia effect and postoperative analgesia effect than surgery under bupivacaine spinal anesthesia,and the former one can more effectively reduce the intraoperative stress response and has less impact on cognitive function of patients,thus it is worthy of clinical promotion.