摘要
目的评价局部浸润麻醉复合全麻在颈椎前路手术临床应用中的可行性和实用性。方法 50例择期行前路颈椎间盘摘除植骨融合内固定手术患者随机分成全麻组(G组)和局部浸润麻醉复合全麻组(LG组),每组25例。两组患者均采用七氟烷吸入复合瑞芬太尼静脉泵注,LG组增加于切皮前于手术切口线皮肤及皮下予0.5%罗哌卡因20 m L逐层局部浸润麻醉。记录两组麻醉前(T0)、切皮前(T1)、切皮即刻(T2)、切皮后1 min(T3)、切皮后5 min(T4)、拔管后5 min(T5)、拔管后30 min(T6)的平均动脉压(MAP)、心率(HR);记录七氟烷、瑞芬太尼和术后镇痛6、12、24、48 h舒芬太尼的用量,采用视觉模拟评分(VAS)评估两组术后上述时点的颈部切口部位疼痛情况,对比两组术后镇痛效果良好(VAS≤3)的例数。结果 G组T2、T3、T5、T6的血压和心率均较同期LG组高,T2、T3的血压和心率较T1升高,T5、T6的血压和心率较T0高(均P<0.05)。LG组瑞芬太尼用量比G组少,患者术后6、12 h的镇痛效果良好病例数较G组多,术后6、12、24、48 h时点镇痛泵舒芬太尼的总用量明显少于G组(均P<0.05)。结论局部浸润麻醉复合全麻用于颈椎前路手术能使血流动力学更加稳定,可显著减少瑞芬太尼和舒芬太尼用量,增强术后镇痛效果。
Objective To evaluate the feasibility and practicability of clinical application of local infiltration anesthesia combined with general anesthesia in anterior cervical operation. Methods Fifty patients undergoing anterior cervical discectomy with fusion and internal fixation were randomly divided into Group G（general anesthesia）and Group LG（local infiltration anesthesia combined with general anesthesia）, 25 patients in each group. Both groups received sevoflurane inhalation and intravenous pumping of remifentanil. Group LG further received 20 m L of 0.5% ropivacaine for local infiltration anesthesia. After then, MAP and HR of both groups were recorded before anesthesia（T0）, before skin incision（T1）, at the moment of skin incision（T2）, 1 min after skin incision（T3）, 5 min after skin incision（T4）, 5 min after extubation（T5） and 30 min after extubation（T6）. The total dose of sevoflurane and remifentanil were recorded. Visual analogue scale（VAS） was used to evaluate the pain at the time points mentioned above. Results MAP and HR of Group G at T2, T3, T5, T6 were higher than those of Group LG. In group G, MAP and HR at T2, T3 were higher than those at T1, while those at T5 and T6 were higher than those at T0（all P〈0.05）. The dosage of remifentanil in group LG was less than that in Group G. There were more cases with good postoperative analgesic effect at 6 and 12 hours after surgery in Group LG compared with Group G. The total amount of sufentanil in group LG was lower than that in Group G at 6, 12, 24, 48 hours after surgery（all P〈0.05）. Conclusion The application of local infiltration anesthesia combined with general anesthesia in anterior cervical operation can make hemodynamics more stable, significantly reduce dosage of remifentanil and sufentanil, and enhance postoperative analgesic effect.
出处
《广东医学院学报》
2015年第3期350-353,共4页
Journal of Guangdong Medical College
关键词
局部浸润麻醉
颈椎前路手术
视觉模拟评分
local infiltration anesthesia
anterior cervical operation
visual analogue scale
