舒芬太尼鞘内注射在经皮椎间孔镜手术中应用.docVIP

舒芬太尼鞘内注射在经皮椎间孔镜手术中应用 　　摘要：目的 探讨舒芬太尼鞘内注射用于经皮椎间孔镜手术术中镇痛的可行性。方法 择期行“经皮椎间孔镜下行椎间盘髓核摘除术”患者60例，随机、双盲分成2组。实验组（A组，n=30），予鞘内注射舒芬太尼7.5μg；对照组（B组，n=30），予1%利多卡因局部浸润麻醉。记录两组患者术中各时点的VAS评分、MAP、HR、麻醉相关不良反应、患者和术者对麻醉的满意等。结果 与B组比较，A组镇痛效果更好，术中血流动力学更为稳定，患者及术者对A组麻醉的满意度显著高于B组。结论 舒芬太尼鞘内注射用于经皮椎间孔镜手术术中镇痛，效果良好，不良反应较少且可控 关键词：舒芬太尼；鞘内注射；椎间孔镜手术 Abstract：Objective To investigate the feasibility of pain relief during operation through the use of sufentanil intrathecal injection in percutaneous transforaminal endoscopic discectomy. Methods 60 patients， being treated with percutaneous transforaminal endoscopic discectomy， were randomly divided into 2 groups. Experimental group A （n=30） were given an intrathecal injection with sufentanil 7.5ug； control group B （n=30） received a 1% lidocaine local infiltration anesthesia. We observed the VAS score， MAP， HR and anesthetic adverse reaction of the patients in the two groups during operation， as well as patients and surgeons’ degree of satisfaction toward anesthesia. Results Compared with group B， the analgesia was significantly better and the emodynamics more stable in group A； patients and surgeons were considerably more satisfied with the anesthesia for group A. Conclusion The analgesic efficacy during operation of sufentanil intrathecal injection in percutaneous transforaminal endoscopic discectomy is comparatively good， adverse reaction smaller and controllable. Key words：Sufentanil； Intrathecal injection； Percutaneous transforaminal endoscopic discectomy ?皮椎间孔镜技术治疗腰椎间盘突出症具有创伤小、出血少、康复快等特点[1-2]，但由于镜下视野及操作空间较小，术者常需要与患者及时沟通，通过患者的反馈，防止在建立手术通道和摘除髓核的过程中误伤神经[3-4]。所以，理想的麻醉方式要求：不影响手术医生与患者的沟通、术中触及神经根时患者能及时感知、最大程度地减少患者手术疼痛。近年，我科采用舒芬太尼鞘内注射的镇痛方法用于经皮椎间孔镜手术，取得了良好的效果，现报道如下 1 资料与方法 1.1一般资料 本研究经医院伦理委员会批准，并与患者及其家属签署知情同意书。择期行“经皮椎间孔镜下行椎间盘髓核摘除术”患者60例，其中L4-5节段22例，L5S1节段38例，年龄40～65岁，ASAⅠ～Ⅱ级，无椎管内阻滞禁忌症，无语言交流障碍，能正确理解、表达视觉模拟评分（Visual Analogue Scale/Score，VAS）。随机、双盲分成两组，实验组（A组，n=30）；对照组（B组，n=30）。所有手术均由熟练掌握此技术的同一脊柱外科医生完成，手术前向患者宣教疼痛性质、程度的描述及评估方法 1.2方法 患者进入手术室后，开放静脉，监