双侧竖脊肌平面阻滞在胸腰椎手术中的应用

Application of bilateral erector spinae plane block in thoracolumbar surgery

目的探究双侧竖脊肌平面阻滞在胸腰椎手术中的应用效果。方法选取2017年1月—2020年6月接受胸腰椎手术的60例患者作为研究对象,采用随机数字表法分为对照组(n=30)和观察组(n=30)。对照组予以全身麻醉,观察组在对照组基础上联合双侧竖脊肌平面阻滞。记录2组患者手术时间、阻滞所需时间、术后气管拔管时间、睁眼时间、麻醉苏醒期躁动发生率及术后麻醉相关并发症发生情况;比较2组患者麻醉恢复情况,术后镇痛情况,包括疼痛视觉模拟量表(VAS)评分、首次静脉自控镇痛泵(PCIA)按压时间、PCIA按压次数、补救性镇痛给药次数,以及2组患者麻醉诱导前(T_(0))、气管插管时(T_(1))、手术结束时(T_(2))、气管拔管时(T_(3))的血流动力学指标,包括收缩压(SBP)、舒张压(DBP)、心率(HR)。结果观察组睁眼时间多于对照组,麻醉苏醒期躁动发生率低于对照组,差异均有统计学意义(P<0.05);2组手术时间、术后气管拔管时间差异无统计学意义(P>0.05)。观察组术后VAS评分、PCIA按压次数、补救性镇痛给药次数低于对照组,首次PCIA按压时间多于对照组,差异均有统计学意义(P<0.05)。观察组患者T_(1)、T_(2)、T_(3)时间点的SBP、DBP、HR低于对照组,差异均有统计学意义(P<0.05)。2组麻醉相关并发症差异无统计学意义(P>0.05)。结论双侧竖脊肌平面阻滞应用于胸腰椎手术有助于维持患者术中血流动力学稳定,减少患者麻醉苏醒期躁动的发生,并提升术后镇痛效果。

Objective To investigate the effect of bilateral erector spinae plane block in thoracolumbar surgery.Methods Sixty patients underwent thoracolumbar surgery from January 2017 to June 2020 were selected as study subjects,and were divided into control group(n=30)and observation group(n=30)by the random number table method.Patients in the control group were given general anesthesia,and patients in the observation group were combined with bilateral erector spinae plane block on the basis of the control group.The operation time,time required for block,postoperative tracheal extubation time,eye opening time,incidence of agitation during anesthesia awakening period and occurrence of postoperative anesthesiarelated complications were recorded in the 2 groups.The anesthesia recovery status,postoperative analgesia including visual analogue scale[VAS]score,time of first patient-controlled intravenous analgesia(PCIA)compression,frequency of PCIA compressions,administration frequency of remedial analgesics and hemodynamics indices(including systolic blood pressure[SBP],diastolic blood pressure[DBP],heart rate[HR])before anesthesia induction(T_(0)),at tracheal intubation(T_(1)),at the end of surgery(T_(2))and at tracheal extubation(T_(3))were compared between the 2 groups.Results The patients in the observation group had more eye opening time than the control group,and incidence of agitation during anesthesia awakening period was lower than that of the control group,and the differences were statistically significant(P<0.05);there was no statistical difference in operation time and postoperative tracheal extubation time between the 2 groups(P>0.05).The VAS score,frequency of PCIA compressions and administration frequency of remedial analgesia in the observation group were lower than those in the control group,and the time of first PCIA compression was longer than that in the control group,and the differences were statistically significant(P<0.05).The SBP,DBP and HR of patients in the observation group at T_(1),T_(2),and T_(3) time points were lower than those in the control group,and the differences were statistically significant(P<0.05).There was no significant difference in postoperative anesthesia-related complications between the 2 groups(P>0.05).Conclusion The application of bilateral erector spinae plane block in thoracolumbar surgery helps maintain intraoperative hemodynamic stability,reduces the occurrence of agitation during the awakening period of anesthesia,and improves postoperative analgesia.