超声引导下竖脊肌平面阻滞对老年患者经皮穿刺椎体后凸成形术中疼痛和满意度的影响

目的探讨超声引导下竖脊肌平面阻滞(ESPB)对经皮球囊扩张椎体后凸成形术(PKP)老年患者术中及术后疼痛及满意度的影响。方法选取2019年12月至2021年7月择期行PKP手术患者100例,年龄65〜85岁,体质量指数17.9〜29.0 kg/m^(2)。按照随机数表法分为对照组(C组)和ESPB组(E组),每组各50例。C组局部浸润麻醉,E组超声引导下竖脊肌平面阻滞。记录患者术前(T_(0))、穿刺针进入椎体内时(T_(1))、球囊扩张时(T_(2))、骨水泥注入即刻(T_(3))、手术结束出室前(T_(4))心率、平均动脉压和视觉模拟评分(VAS)及术后3 h(T_(5))、术后6h(T_(6))、术后12h(T_(7))、术后24h(T_(8))和术后48h(T_(9))VAS评分。患者¥八5评分>3分时使用酮咯酸氨丁三醇1511^单次静注止痛,如疼痛未缓解或VAS评分>6分时则使用芬太尼静推止痛,首次剂量0.4μg/kg,后续追加剂量0.2 μg/kg,追加间隔不<5 min;密切关注患者呼吸,若呼吸频率<8次/min,则停止使用阿片类药物并采取开放气道等措施。术毕评价患者对手术的满意度及再次接受类似手术的意愿。结果与C组比较,E组患者T_(1)、T_(2)、T_(3)时心率、平均动脉压明显降低,差异有统计学意义(P<0.05);在T_(1)〜T_(7)时点E组患者VAS评分低于C组,差异有统计学意义(P<0.01);E组芬太尼使用率为41.3%,C组芬太尼使用率83%,差异有统计学意义(P<0.05);E组患者手术满意和一般比例分别为56.5%和34.8%,C组则分别为21.3%和55.3%,差异有统计学意义(P<0.05)。结论老年患者PKP手术时ESP阻滞能适度降低患者术中疼痛,减轻围术期循环波动,为术后早期提供良好的镇痛,提高患者满意度。

Objective To investigate the effect of ultrasound—guided erector spinae plane block(ESPB)on intraoperative and postoperative pain and satisfaction of elderly patients with percutaneous balloon kyphoplasty(PKP).Methods 100 patients,aged 65~85 years,with body mass index of 17.9〜29.0 kg/m^(2),undergoing elective PKP surgery in two hospitals from December 2019 to July 2021 were enrolled in the study.The eligible patients were divided into two groups:control group(group C,n=50)and ESP group(group E,n=50)based on computer generated random table.Local infiltration anesthesia was conducted in group C,ESPB was performed in group E.The heart rate,mean blood pressure and visual analogue score(VAS)were recorded in the following rime-pointsibefore operation(T_(O)),needle entering the vertebral body(T_(1)),during balloon dilatation(T_(2)),instant after injection of bone cement(T_(3)),before the end of operation(T_(4)),3 h(T_(5)),6 h(T_(6)),12 h(T_(7)),24 h(T_(8))and 48 h(T_(9))postoperatively.Patients with VAS score greater than 3 were treated with ketorolac tromethamine(Ketorolac)15 mg for a single injection to relieve pain.Fentanyl 0.4μg/kg were intravenously administered when the pain has not been mitigated or VAS score above 6,the incremental dose for fentanyl was 0.2μg/kg with 5 minutes interval.Mandates close monitoring for respiratory status,stop using opioids and take measures to open airway when respiratory rate less than 8 times per minute.Patients'satisfaction and willingness to reoperation were assessed.Results Compared with group C,heart rate at T_(1),T_(2) and T_(3) was significantly lower and the mean blood pressure was lower in group E(P<0.05).The VAS scores of group E at T_(1)~T_(7) after operation was significandy lower than that in group C(P<0.01).In group E,the utilization rate of fentanyl was 41.3%.In group C,the utilization rate of fentanyl was 83%(P<0.05).In group E,the proportion of satisfaction and normal with the operation was 56.5%,34.8%,respectively,and the corresponding values of patients in group C were 21.3%,55.3%,respectively(P<0.05),and the patients accepted the assumed reoperarion option due to the satisfaction about the experience.Conclusion ESPB in elderly patients undergoing PKP can moderately reduce the patient's intraoperative pain,provides good analgesia after surgery.ameliorates perioperative hemodynamic fluctuations,and improves patient satisfaction and willingness to reoperate.