全麻复合竖脊肌阻滞应用于腰椎融合术的效果△

Effect of additional ultrasound-guided erector spinae plane block in general anesthesia for lumbar fusion

摘要:

［目的］ 评价腰椎融合术超声引导下竖脊肌阻滞效果的临床研究。［方法］ 60 例全身麻醉下行腰椎融合手术患者纳入本研究。根据医患沟通结果，30 例术前均加竖脊肌阻滞麻醉，30 例常规全麻，未增加阻滞麻醉。比较两组临床效果。［结果］ 两组患者均顺利完成手术。阻滞组各时间点 MAP、HR 平稳 （P>0.05），但常规组在切皮和切除椎间盘时显著上升 （P< 0.05），两组间差异有统计学意义（P<0.05）。阻滞组术中舒芬太尼用量、苏醒室停留时间显著少于常规组（P<0.05）。术后 24 h 阻滞组 QoR-15 评分显著高于常规组（P<0.05），但术后 48 h 两组间 QoR-15 评分差异无统计学意义（P>0.05）。此外，术后 6、12 h 阻滞组的静息和活动 NRS 均显著低于常规组（P<0.05），但术后 24 h 两组间 NRS 的差异无统计学意义（P>0.05）。阻滞组术后 48 h 舒芬太尼用量显著少于常规组（P<0.05），且不良反应发生率显著降低（P<0.05）。［结论］ 超声引导下竖脊肌阻滞用于腰椎融合手术，可改进镇痛效果，并减少不良反应。

Abstract:

[Objective] To evaluate the effect of additional ultrasound-guided erector spinae plane block in general anesthesia for lum- bar fusion. [Methods] A total of 60 patients who received lumbar fusion under general anesthesia were included in this study. According to the results of doctor- patient communication, 30 patients had erector spine block added before surgery, while the remaining 30 patients were treated with conventional general anesthesia without block anesthesia. The clinical outcomes of the two groups were compared. [Results] All patients in both groups were successfully operated on. The mean artery pressure (MAP) and heart rate (HR) remained stable in the block group at each time point (P＞0.05) , whereas which significantly increased at skin cutting and disc resection in the routine group (P＜0.05) , with statistically significant differences between them (P＜0.05) . The block group proved significantly superior to the routine group in terms of amount of sufentanil used and stay time in recovery room (P＜0.05) . In addition, the block group was also superior to the routine group in the qOR-15 score 24 h after surgery (P＜0.05) , despite that became not significant between the two groups 48 h after sur- gery (P＞0.05) . Furthermore, the block group proved significantly superior to the routine group in the resting and active NRS scores at 6 h and 12 h after surgery, whereas which became not statistically significant between them at 24 h after surgery (P＞0.05) . Moreover, the block group had significantly lower dosage of sufentanil consumed than the routine group 48 h after operation (P＜0.05) , with significantly lower incidence of adverse reactions (P＜0.05) . [Conclusion] The additional ultrasound-guided erector spinae plane block does improve the anal- gesic effect and reduce the adverse reactions in general anesthesia for lumbar fusion surgery in this study.