国际麻醉学与复苏杂志   2020, Issue (2): 9-9
    
气管插管全身麻醉复合腰方肌阻滞用于腰椎手术的效果评价
林金兵, 杨承祥, 梁桦, 刘幸清, 文先杰1()
1.佛山市第二人民医院
Evaluation of the application of general anesthesia with tracheal intubation combined with quadratus lumborum block in lumbar spine surgery
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摘要:

目的 评价气管插管全身麻醉复合腰方肌阻滞(quadratus lumborum block, QLB)用于腰椎手术的临床效果。 方法 择期行腰椎手术的患者50例,ASA分级Ⅰ~Ⅲ级,采用随机数字表法将患者分为2组(每组25例):对照组(C组)和QLB组(N组)。全身麻醉诱导前N组患者在超声引导下行双侧QLB,在每侧腰方肌和腰大肌之间的筋膜注射0.5%盐酸罗哌卡因15 ml。C组不做QLB,单纯气管插管全身麻醉完成手术。记录患者术前(T0)、麻醉诱导气管插管后即刻(T1)、手术开始前(T2)、手术结束时即刻(T3)、患者清醒拔管后即刻(T4)时点的MAP、心率、SpO2等指标;记录两组患者手术时间、出血量、补液量、术者对肌松满意度评分;记录患者T4、术后4 h(T5)、术后8 h(T6)、术后12 h(T7)、术后24 h(T8)和术后48 h(T9)时静态VAS评分,T7~T9时动态VAS评分;记录术中丙泊酚、瑞芬太尼、顺苯磺酸阿曲库铵用量;记录术后24 h内舒芬太尼用量、患者自控静脉镇痛(patient‑controlled intravenous analgesia, PCIA)总按压次数、需额外使用静脉镇痛药补救镇痛的例数;记录术后发生恶心呕吐、呼吸抑制等并发症情况。 结果 两组患者一般情况差异无统计学意义(P>0.05);N组患者各时点VAS评分均低于C组(P<0.05);N组患者丙泊酚、瑞芬太尼、顺苯磺酸阿曲库铵、舒芬太尼用量比C组降低(P<0.05);N组术后镇痛补救例数、不良反应发生率低于C组(P<0.05);手术医师对N组的肌松满意度高于C组(P<0.05)。 结论 气管插管全身麻醉复合QLB用于腰椎手术患者的麻醉可以减少全身麻醉药用量,降低不良反应发生率,并降低术后VAS评分,是一种可行的麻醉方法。

关键词: 腰椎手术;全麻;腰方肌阻滞;术后镇痛;
Abstract:

Objective To evaluate the clinical application of general anesthesia with tracheal intubation combined with quadratus lumborum block (QLB) in lumbar spine surgery. Methods Fifty patients with American Society of Anesthesiologists (ASA) Ⅰ‒Ⅲ who were scheduled for lumbar spine surgery were divided into two groups according to the random number table method (n=25): a control group (group C) and a QLB (group N). Before the induction of general anesthesia, patients in group N received bilateral QLB under the guidance of ultrasound, and were injected with 15 ml of 0.5% ropivacaine hydrochloride between the quadratus lumborum and psoas major muscle on each side. Group C did not undergo QLB, but completed operation under general anesthesia with tracheal intubation. The mean blood pressure (MAP), heart rate, pulse oxygen saturation (SpO2) were recorded before surgery (T0), immediately after anesthesia induction with endotracheal intubation (T1), before the starting of surgery (T2), at the end of surgery (T3), and immediately after extubation (T4). The operation time, blood loss, fluid intake and the score of surgeon’s satisfaction towards muscle relaxation were recorded. The Visual Analogue Scale (VAS) scores at resting were recorded at T4, 4 h after surgery (T5), 8 h after surgery (T6), 12 h after surgery (T7), 24 h after surgery (T8) and 48 h after surgery (T9). The VAS scores during movement were recorded from T7 to T9. The perioperative doses of propofol, remifentanil and cisatracurium besylate were recorded. The dose of sufentanil within 24 h after surgery, the pressing times of patient‑controlled intravenous analgesia (PCIA) and the number of additional use of intravenous anesthetics for remediation were recorded. Postoperative complications such as nausea, vomiting and respiratory depression were recorded. Results There was no statistical difference in general information between the two groups (P>0.05). The VAS score of group N was lower than that of group C at each time point (P<0.05). The doses of propofol, remifentanil, cisatracurium besylate and sufentanil used in group N were significantly lower than those in group C (P<0.05). The number of postoperative analgesic remediation cases and the incidence of adverse reactions in group N were significantly lower than those in group C (P<0.05). Meanwhile, the surgeons presented better muscle relaxation satisfaction towards group N than group C (P<0.05). Conclusions The application of general anesthesia with tracheal intubation combined with QLB in patients for lumbar spine surgery can reduce the doses of general anesthetics, decrease the incidence of adverse reactions, and decline the VAS score after surgery, which is a feasible method of anesthesia.

Key words: Lumbar spine surgery; Anesthesia, general; Quadratus lumborum block; Postoperative analgesia