超声引导下ESPB在老年经皮椎体成形术中的应用

Application of ultrasound-guided erector spinae plane block in percutaneous vertebroplasty for elderly patients

目的探讨超声引导下竖脊肌平面阻滞(ESPB)在老年经皮椎体成形术中的应用效果。方法选取2023年12月至2024年6月于博罗县人民医院拟接受经皮椎体成形术的80例老年患者作为研究对象,按随机数表法分为观察组和对照组各40例。对照组患者采用局部浸润麻醉,观察组患者采用超声引导下ESPB麻醉。比较两组患者的手术时间及术中舒芬太尼、乌拉地尔使用率,比较两组患者术前(T0)、穿刺定位时(T1)、球囊扩张时(T2)、注入骨水泥时(T3)、手术结束时(T4)各时间点的VAS评分、平均动脉压(MAP)、心率(HR)的变化,同时比较两组患者的不良反应发生率。结果观察组患者的舒芬太尼、乌拉地尔使用率分别为7.50%、5.00%,明显低于对照组的27.50%、22.50%,差异均有统计学意义(P<0.05);观察组患者T2、T3、T4时间点的VAS评分分别为(1.22±0.28)分、(1.52±0.33)分、(1.47±0.31)分,明显低于对照组的(2.35±0.37)分、(2.79±0.41)分、(2.65±0.45)分,差异均有统计学意义(P<0.05);观察组患者T2、T3、T4时间点的MAP分别为(105.97±4.22)mm Hg、(107.98±4.71)mm Hg、(108.34±4.58)mm Hg,明显低于对照组的(110.87±5.17)mm Hg、(115.86±6.32)mm Hg、(117.27±5.14)mm Hg,HR分别为(88.21±4.18)次/min、(89.45±4.66)次/min、(90.32±4.87)次/min,明显低于对照组的(91.58±4.49)次/min、(92.67±4.31)次/min、(93.18±5.22)次/min,差异均有统计学意义(P<0.05);观察组患者的不良反应总发生率为10.00%,略低于对照组的12.50%,但差异无统计学意义(P>0.05)。结论超声引导下ESPB在老年经皮椎体成形术中的应用效果明显,可缓解术中疼痛、稳定血流动力学,具有临床应用价值。

Objective To investigate the application effect of ultrasound-guided erector spinae plane block(ESPB)in percutaneous vertebroplasty for the elderly.Methods A total of 80 elderly patients receiving percutaneous vertebroplasty in Boluo County People's Hospital from December 2023 to June 2024 were selected and divided into an observation group and a control group according to random number table method,with 40 patients in each group.Patients in the control group were given local infiltration anesthesia,and those in the observation group were given ultrasound-guided ESPB.The operative duration and intraoperative utilization rate of sufentanil and urapidil were compared between the two groups.The changes of VAS scores,mean arterial pressure(MAP),and heart rate(HR)before surgery(T0),during puncture positioning(T1),balloon dilation(T2),bone cement injection(T3),and at the end of surgery(T4)were compared between the two groups.The incidence of adverse reactions was also compared.Results The utilization rates of sufentanil and urapidil in the observation group were 7.50%and 5.00%,which were significantly lower than 27.50%and 22.50%in in the control group(P<0.05).The VAS scores at T2,T3,and T4 in the observation group were(1.22±0.28)points,(1.52±0.33)points,and(1.47±0.31)points,which were significantly lower than(2.35±0.37)points,(2.79±0.41)points,and(2.65±0.45)points in the control group(P<0.05).The MAP at T2,T3,and T4 in the observation group were(105.97±4.22)mmHg,(107.98±4.71)mmHg,and(108.34±4.58)mmHg,respectively,which were significantly lower than(110.87±5.17)mmHg,(115.86±6.32)mmHg,and(117.27±5.14)mmHg in the control group;the HR were(88.21±4.18)times/min,(89.45±4.66)times/min,and(90.32±4.87)times/min,respectively,which were significantly lower than(91.58±4.49)times/min,(92.67±4.31)times/min,and(93.18±5.22)times/min in the control group;the differences were statistically significant(P<0.05).The total incidence of adverse reactions in the observation group was 10.00%,which was slightly lower the than 12.50%in the control group(P>0.05).Conclusion The application of ultrasound-guided ESPB in percutaneous vertebroplasty for the elderly has significant effects,which can alleviate intraoperative pain,stabilize hemodynamics,and is worthy of promotion and application.