右美托咪定竖脊肌阻滞对椎间孔镜术镇痛影响

Effects of dexmedetomidine combined with erector spinal block on analgesia in percutaneous transforaminal endoscopic dis⁃ cectomy

摘要:

［目的］ 探讨右美托咪定 （dexmedetomidine, Dex） 竖脊肌阻滞对椎间孔镜术镇痛的影响。［方法］ 2019 年 3 月— 2020 年 3 月，本院 89 例拟行椎间孔镜术患者纳入本研究，采用随机数字表法将患者分为两组。其中，Dex 组 45 例，给予 Dex 竖脊肌阻滞；非 Dex 组 44 例，给予常规局部麻醉。比较两组术中生命体征变化和镇痛效果。［结果］ 术前两组间 MAP 和 HR 的差异均无统计学意义 （P>0.05）；而在手术开始时、切除关节突时、切除髓核时 （T3） 和手术结束时，Dex 组的 MAP 及 HR 均显著低于非 Dex 组 （P<0.05）；相应时间点，两组间 SPO₂的差异均无统计学意义 （P>0.05）。相应时间点，Dex 组的 VAS 评分均显著低于非 Dex 组（P<0.05）。Dex 组术中舒芬太尼消耗量、术中舒适度 NRS 评分、恢复室停留时间、术后 6 h 和 12 h 的 PCIA 按压次数均显著优于非 Dex 组（P<0.05）。［结论］Dex 竖脊肌阻滞能够延长椎间孔镜术患者镇痛时间，提高患者围手术期的舒适度。

Abstract:

[Objective] To explore the effect of dexmedetomidine (Dex) combined with erector spinal block on analgesia in percutane- ous transforaminal endoscopic discectomy (PTED) . [Methods] From March 2019 to March 2020, a total of 89 patients who were undergo- ing PTED in our hospital were enrolled in this study, and were divided into two groups by random number table method. Of them, 45 pa- tients in the Dex group were treated with Dex combined with erector spine block, while the other 44 patients in the non-DEX group were given conventional local anesthesia. The patients in the two groups were compared regarding to the variation of vital signs and analgesic ef- fect. [Results] Although there were no statistically significant differences in mean artery pressure (MAP) and heart rate (HR) between the two groups before operation (P＞0.05) , the Dex group had significantly lower MAP and HR than the non-DEX group at the beginning of sur- gery, the removal of the facet, the removal of the nucleus pulposus and the end of surgery (P＜0.05) . However, there were no significant dif- ferences in SPO₂ between the two groups at corresponding time points (P＞0.05) . The Dex group got significantly lower VAS scores than the non-DEX group at all matching time points (P＜0.05) . The Dex group was significantly superior to the non-DEX group in terms of intraoper- ative sufentanil consumption, intraoperative comfort NRS score, recovery room stay, and PCIA pressing times 6 and 12 h after operation (P＜ 0.05) . [Conclusion] The Dex combined with erector spinal block does prolong the analgesic time and improve the perioperative comfort in PTED.