硬膜外注射甲磺酸罗派卡因麻醉在椎间孔镜手术中的应用
Epidural injection of Ropivacaine Mesylate anesthesia in transforaminal endoscopic surgery
张娟 1刘瑶 1贾洪峰 1张波2
作者信息
- 1. 西安交通大学附属3201医院 麻醉科,陕西 汉中 723000
- 2. 西安交通大学附属3201医院 骨科,陕西 汉中 723000
- 折叠
摘要
目的 对比分析不同局麻药配方在连续硬膜外下行经皮椎间孔镜隋核摘除术的临床观察.方法 选择2015年11月～2016年11月行经皮椎间孔镜下突出椎间盘切除术(PTED)患者共40例,根据患者对麻醉的选择分为A组和B组,每组20例.A组选用0.5％利多卡因局部麻醉,B组采用连续硬膜外麻醉(1％利多卡因3 mL+0.5％罗哌卡因);分析2组术前、术中的疗效、VAS评分、改良Bromage评分,术中疼痛感受包括四个标准,即无、轻度、中度、重度,前两者为麻醉效果满意;后2者为麻醉不满意.结果 2组病例术后均无发生脑脊液漏、神经根损伤等并发症;2组患者术中发生疼痛满意度比较差异有统计学意义(P<0.05);与A组相比较,B组术中MAP、HR更平稳(P<0.05).结论 连续硬膜外麻醉较局部麻醉更适合完成PTED,它可以减少患者术中疼痛及心脑血管意外的发生,同时也不影响患者的下肢运动评分.
Abstract
Objective To compare and analyze the clinical effects of different local anesthetics on continuous epidural anesthesia for percutaneous enucleation of nucleus pulposus. Methods A total of 40 patients underwent lumbar intervertebral discoscopy (PTED) from November 2015 to November 2016, according to the choice of anesthesia is divided into group A and group B, 20 cases in each group. Group A used 0.5％lidocaine local anesthesia, group B treated with continuous epidural anesthesia (1 ％ lidocaine 3 mL+0.5％ ropivacaine).Analysis of two groups before operation, the curative effect, VAS score, modified Bromage score, intraoperative pain perception includes four criteria, namely, mild, moderate and severe, the former two satisfactory anesthetic effect; the latter two are not satisfied with the anesthesia. Results Two cases without postoperative cerebrospinal fluid leakage occurred, nerve root injury and other complications; two groups of patients with pain satisfaction difference was statistically significant (P<0.05); compared with group A, the levels of HR and MAP in group B were more stable (P<0.05). Conclusion Continuous epidural anesthesia is more suitable for PTED than local anesthesia. It can reduce the pain and the occurrence of cardiovascular and cerebrovascular accidents in patients, and does not affect the patients' lower limb movement score.
关键词
麻醉/椎间孔镜/腰椎间盘突出症/观察Key words
anesthesia/intervertebral foramen endoscope/protrusion of lumbar intervertebral disc/observation引用本文复制引用
出版年
2017
NETL
NSTL
维普
万方数据