胸椎旁神经阻滞辅助局部麻醉用于老年患者经皮椎体成形术中的应用效果

中华养生保健 ›› 2024, Vol. 42 ›› Issue (19): 166-170.

胸椎旁神经阻滞辅助局部麻醉用于老年患者经皮椎体成形术中的应用效果

倪红艳¹, 阚厚铭¹, 徐向阳¹, 李前胜¹, 王元琳^2,*

1.江苏省泗阳医院麻醉科,江苏宿迁,223700;
2.淮安市第一人民医院麻醉科,江苏淮安,223300

出版日期:2024-10-01 发布日期:2024-09-25
通讯作者: ^*王元琳,E-mail：wangyuanlin1981@163.com。
作者简介:倪红艳（1977—）,女,汉族,籍贯：江苏省宿迁市,本科,主任医师,研究方向：临床麻醉和慢性疼痛诊疗。
基金资助:
江苏省333人才项目资助项目（BRA2018261）; 宿迁市指导性科技计划项目（Z2021037）

The Application Effect of Thoracic Paravertebral Nerve Block Assisted Local Anesthesia in Percutaneous Vertebroplasty in Elderly Patients

NI Hong-yan¹, KAN Hou-ming¹, XU Xiang-yang¹, LI Qian-sheng¹, WANG Yuan-lin^2,*

1. Anesthesiology Department, Jiangsu Province Siyang Hospital, Suqian, Jiangsu 223700, China;
2. Anesthesiology Department, Huai'an First People's Hospital, Huai'an, Jiangsu 223300, China

Online:2024-10-01 Published:2024-09-25

摘要/Abstract

摘要： 目的观察胸椎旁神经阻滞辅助局部麻醉在经皮椎体成形术中的应用效果。方法选取2021年6月—2022年8月于江苏省泗阳医院收治的60例经皮椎体成形术患者作为研究对象,按照随机数表法将其分为观察组（胸椎旁神经阻滞辅以局部麻醉）与对照组（局部麻醉）,每组30例。观察两组患者于不同时点时数字量表评分（NRS）、平均动脉压（MAP）、心率（HR）、血氧饱和度（SpO₂）、Ramsay评分及不良反应发生情况。结果两组患者在手术前（T0）和手术结束（T3）时MAP、HR比较,差异无统计学意义（P>0.05）。在穿刺（T1）和骨水泥注入（T2）时,观察组MAP和HR低于对照组,差异有统计学意义（P<0.05）。两组患者血氧饱和度（SpO₂）在T0、T1、T2、T3四个时间点比较,差异均无统计学意义,差异有统计学意义（P>0.05）。两组患者在手术结束（T3）时Ramsay评分、数字量表评分（NRS）比较,差异无统计学意义（P>0.05）。在穿刺（T1）和骨水泥注入（T2）时,观察组Ramsay评分、NRS评分均低于对照组,差异有统计学意义（P<0.05）。两组患者均无严重不良反应发生,差异无统计学意义（P>0.05）。结论经皮椎体成形术患者采用超声引导下胸椎旁神经阻滞辅助局部麻醉治疗,可以有效改善患者术中疼痛,稳定患者生命体征。

关键词: 超声引导, 胸椎旁神经阻滞, 局部麻醉, 经皮椎体成形术, 骨质疏松性椎体压缩性骨折, 麻醉效果

Abstract: Objective Observe the application effect of thoracic paravertebral nerve block assisted local anesthesia in percutaneous vertebroplasty. Methods Sixty patients undergoing percutaneous vertebroplasty admitted to Jiangsu Province Siyang Hospital from June 2021 to August 2022 were selected as the study subjects and randomly divided into an observation group (thoracic paravertebral nerve block supplemented by local anesthesia) and a control group (local anesthesia) using a numerical table method, with 30 patients in each group. Observe the digital scale score (NRS), mean arterial pressure (MAP), heart rate (HR), blood oxygen saturation (SpO₂), Ramsay score, and incidence of adverse reactions in two groups of patients at different time points. Results There was no statistically significant difference in mean arterial pressure (MAP) and heart rate (HR) between the two groups of patients before surgery (T0) and after surgery (T3) (P>0.05). During puncture (T1) and bone cement injection (T2), the MAP and HR of the observation group were lower than those of the control group (P<0.05). There was no statistically significant difference in blood oxygen saturation (SpO2) between the two groups of patients at the four time points T0, T1, T2, and T3 (P>0.05). There was no statistically significant difference in Ramsay score and Numerical Rating Scale (NRS) between the two groups of patients at the end of surgery (T3) (P>0.05). During puncture (T1) and bone cement injection (T2), the Ramsay score and NRS score in the observation group were lower than those in the control group (P<0.05). There were no serious adverse reactions in both groups of patients (P>0.05). Conclusion Patients undergoing percutaneous vertebroplasty can effectively improve intraoperative pain and stabilize their vital signs by using ultrasound-guided thoracic paravertebral nerve block as an auxiliary local anesthesia treatment.

Key words: ultrasound guided, thoracic paravertebral nerve block, local anesthesia, percutaneous vertebro plasty, osteoporotic vertebral compression fracture, anesthetic effect

中图分类号:

R614
R681

倪红艳, 阚厚铭, 徐向阳, 李前胜, 王元琳. 胸椎旁神经阻滞辅助局部麻醉用于老年患者经皮椎体成形术中的应用效果[J]. 中华养生保健, 2024, 42(19): 166-170.

NI Hong-yan, KAN Hou-ming, XU Xiang-yang, LI Qian-sheng, WANG Yuan-lin. The Application Effect of Thoracic Paravertebral Nerve Block Assisted Local Anesthesia in Percutaneous Vertebroplasty in Elderly Patients[J]. ZHONGHUA YANGSHENG BAOJIAN, 2024, 42(19): 166-170.

参考文献

[1] WANG B, ZHAO C P, SONG L X, et al.Balloon kyphoplasty versus percutaneous vertebroplasty for osteoporotic vertebral compression fracture: a meta-analysis and systematic review[J]. J Orthop Surg Res,2018,13(1):264.
[2] LUTHMAN S, WIDEN J, BORGSTROM F.Appropriateness criteria for treatment of osteoporotic vertebral compression fractures[J]. Osteoporos Int,2018,29(4):793-804.
[3] 毛海青, 周非非, 蔡思逸, 等. 椎体成形术和椎体后凸成形术加速康复实施流程专家共识[J]. 中华骨与关节外科杂志,2019,12(8):561-571.
[4] 包利帅, 王宏. 经皮椎体后凸成形术的麻醉方式的现状及展望[J]. 现代临床医学,2021,47(1):73-75.
[5] 胥凯凯,薛星星,崔永,等.不同途径胸椎旁神经阻滞在胸腔镜术后镇痛中的应用分析[J].临床和实验医学杂志,2023,22(10):1118-1121.
[6] 邱贵兴,裴福兴,胡侦明,等.中国骨质疏松性骨折诊疗指南——骨质疏松性骨折诊断及治疗原则[J].黑龙江科学,2018,9(2):85-88.
[7] ELY E W, TRUMAN B, SHINTANI A, et al.Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond Agitation-Sedation Scale (RASS)[J]. JAMA,2003,289(22):2983-2991.
[8] 李素艳, 赵军红. 骨质疏松性椎体压缩性骨折术后生活质量及危险因素分析[J]. 哈尔滨医药,2021,41(1):48-49.
[9] JI C, RONG Y, WANG J, et al.Risk Factors for Refracture following Primary Osteoporotic Vertebral Compression Fractures[J]. Pain Physician,2021,24(3):E335-E340.
[10] 张宁, 蔡飞, 李长红, 等. 手法复位结合弯角经皮椎体成形术与单纯经皮椎体后凸成形术治疗骨质疏松性椎体压缩性骨折的效果比较[J]. 中国医药导报,2021,18(21):79-83.
[11] 郑筱亭, 王滨城, 吕碧涛, 等. 经皮椎体成形术治疗骨质疏松性椎体压缩性骨折术中采用椎旁神经阻滞的镇痛效果[J]. 脊柱外科杂志,2021,19(6):377-381.
[12] 王丽阳, 尤肖丽, 许辉, 等. 超声引导下椎旁神经阻滞联合全身麻醉对多发肋骨骨折患者术后镇痛效果及围术期应激反应的影响[J]. 海南医学,2023,34(13):1876-1879.
[13] 王李琴, 方景. 经皮椎体成形术联合椎旁神经阻滞对老年骨质疏松椎体压缩性骨折患者疼痛、关节功能的影响[J]. 实用临床医药杂志,2020,24(9):16-19.
[14] IWASAKI M, EDMONDSON M, SAKAMOTO A, et al.Anesthesia, surgical stress, and “long-term” outcomes[J]. Acta Anaesthesiol Taiwan,2015,53(3):99-104.
[15] 白静, 张银福, 赵义康, 等. 对比分析超声引导下椎旁神经阻滞与肋间神经阻滞在脊柱手术患者应用效果及对血流动力学的影响[J]. 现代生物医学进展,2022,22(21):4148-4152.