对比分析超声引导下椎旁神经阻滞与肋间神经阻滞在脊柱手术患者应用效果及对血流动力学的影响

Comparative Analysis of Ultrasound-guided Paravertebral Nerve Block and Intercostal Nerve Block in Patients with Spinal Surgery and Their Effects on Hemodynamics

目的:对比分析超声引导下椎旁神经阻滞与肋间神经阻滞在脊柱手术患者应用效果及对血流动力学的影响。方法:选择西安交通大学第一附属医院2020年6月至2021年12月收治的脊柱骨折患者96例作为研究对象,根据1:1随机数字表法把患者分为椎旁神经阻滞组与肋间神经阻滞组各48例。所有患者均给予脊柱手术治疗,所有手术操作都由同一组医生完成,椎旁神经阻滞组与肋间神经阻滞组分别给予超声引导下椎旁神经阻滞与肋间神经阻滞,记录两组阻滞效果及对血流动力学的影响。结果:两组通气5 min、通气30 min、恢复双肺通气30 min等时间点的HR、SPO2值在组内与组间对比无差异(P>0.05)。两组的术中补液量、术中出血量、手术时间、麻醉时间、术中尿量等对比无差异(P>0.05)。椎旁神经阻滞组的坐骨神经运动神经、感觉神经阻滞持续时间都少于肋间神经阻滞组(P<0.05),两组运动神经、感觉神经阻滞起效时间对比无差异(P>0.05)。椎旁神经阻滞组术后7 d的肺部感染、肺栓塞、呼吸衰竭等肺部并发症发生率2.1%,低于肋间神经阻滞组的16.7%(P<0.05)。结论:相对于肋间神经阻滞,超声引导下椎旁神经阻滞在脊柱手术患者并不会影响患者的血流动力学状况,也不会影响手术与麻醉过程,还可缩短坐骨神经运动神经、感觉神经阻滞持续时间,减少术后并发症的发生。

Objective: To compare and analysis the application effects of ultrasound-guided paravertebral nerve block and intercostal nerve block in patients with spinal surgery and their effect on hemodynamics. Methods: From June 2020 to December 2021, A total of 96 patients with spinal fractures admitted to The First Affiliated Hospital of Xi ’an Jiaotong University were selected as the research subjects, and the patients were divided into paravertebral nerve block group and intercostal nerve block group accorded to the 1:1 random number table method. 48 cases each. All patients were given spinal surgery, and all surgical operations were performed by the same group of doctors. The paravertebral nerve block group and the intercostal nerve block group were given ultrasound-guided paravertebral nerve block and intercostal nerve block, respectively. The block effect and its effect on hemodynamics were recorded. Results: There were no difference in HR and SPO2compared between the two groups at time points such as ventilation for 5 minutes, ventilation for 30minutes, and recovery of bilateral lung ventilation for 30 minutes(P>0.05). There were no difference in intraoperative fluid volume,intraoperative blood loss, operation time, anesthesia time, and intraoperative urine volume compared between the two groups(P>0.05). The duration of sciatic motor and sensory nerve blocks in the paravertebral nerve block group were shorter than that in the intercostal nerve block group(P<0.05), and there were no difference in the onset time of motor and sensory nerve blocks compared between the two groups(P>0.05). The incidence rates of pulmonary complications such as pulmonary infection, pulmonary embolism, and respiratory failure in the paravertebral nerve block group were 2.1 % at 7 days after operation, which were lower than that in the intercostal nerve block group(16.7 %)(P<0.05). Conclusion: Compares with intercostal nerve block, ultrasound-guided paravertebral nerve block does not affect the hemodynamic status of patients with spinal surgery, nor does it affect the operation and anesthesia process. It can also shorten the duration of sciatic motor and sensory nerve blocks and reduce the occurrence of postoperative complications.