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[1]熊华平,吴志云,庄海滨,等.不同浓度罗哌卡因硬膜外麻醉在经皮椎间孔镜手术中的应用对比[J].医学研究与战创伤救治(原医学研究生学报),2023,25(3):257-260.[doi:10.3969/j.issn.1672-271X.2023.03.007]
　XIONG Huaping,WU Zhiyun,ZHUANG Haibin,et al.Comparison of epidural anesthesia with different concentrations of ropivacaine in percutaneous transforaminal endoscopic surgery[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2023,25(3):257-260.[doi:10.3969/j.issn.1672-271X.2023.03.007]
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不同浓度罗哌卡因硬膜外麻醉在经皮椎间孔镜手术中的应用对比()
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《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第25卷
期数:
2023年3期
页码:
257-260
栏目:
临床研究
出版日期:
2023-08-01

文章信息/Info

Title:
Comparison of epidural anesthesia with different concentrations of ropivacaine in percutaneous transforaminal endoscopic surgery
作者:
熊华平; 吴志云; 庄海滨; 张海华
作者单位：362000泉州，解放军联勤保障部队第九一○医院麻醉科（熊华平、吴志云、庄海滨、张海华）
Author(s):
XIONG Huaping;  WU Zhiyun;  ZHUANG Haibin;  ZHANG Haihua
(Department of Anesthesiology, the 910th Hospital of the Joint Logistics Support Force，PLA，Quanzhou 362000, Fujian, China)
关键词:
腰椎间盘突出症; 不同浓度; 罗哌卡因; 硬膜外麻醉; 经皮椎间孔镜手术
Keywords:
lumbar disc herniation;  different concentration;  ropivacaine;  epidural anesthesia;  percutaneous transforaminal endoscopic surgery
分类号:
R614
DOI:
10.3969/j.issn.1672-271X.2023.03.007
文献标志码:
A
摘要:
目的探讨不同浓度罗哌卡因硬膜外麻醉在经皮椎间孔镜手术中的应用效果。方法选取2020年6月-2021年12月于解放军联勤保障部队第九一○医院行经皮椎间孔镜手术治疗的腰椎间盘突出症患者105例作为研究对象，根据随机数字表法分为高浓度组、中浓度组、低浓度组，每组35例，高、中、低浓度组所使用的罗哌卡因浓度分别为0.4%、0.3%和0.2%。观察比较3组患者在不同时间点[麻醉前（T0）、切皮（T1）、扩张通道（T2）、刺激神经根（T3）及缝皮（T4）]的心率（HR）、平均动脉压（MAP）、视觉模拟评分（VAS）和下肢运动功能阻滞评分。下肢运动功能采用改良Bromage评分表评估。分别于术前和术后1个月采用Oswestry功能障碍指数问卷表（ODI）评估腰痛对患者日常生活的影响。结果3组患者在T1-T4时HR、MAP、VAS与Bromage评分均有明显差异，其中高浓度组HR（69.52±7.36、71.13±7.41、71.07±6.95、70.35±7.47次/min）、MAP（77.41±7.46、79.34±8.05、80.25±7.88、78.37±8.23 mmHg）与VAS评分（0.27±0.55、1.30±0.57、0.98±0.56、0.45±0.38分）、中浓度组HR（72.43±7.48、73.76±7.56、73.42±8.13、73.66±7.29次/min）、MAP（83.25±7.62、84.13±7.92、82.34±8.29、81.53±6.94 mmHg）与VAS评分（0.41±0.62、1.56±0.58、1.23±0.69、0.52±0.50分），均低于低浓度组HR（78.65±7.72、80.39±7.60、82.58±7.44、80.91±8.30次/min）、MAP（89.55±9.14、92.61±9.40、91.45±9.33、91.81±10.20 mmHg）与VAS评分（2.24±0.81、3.74±0.85、4.14±1.10、2.82±0.93分），高浓度组Bromage评分（1.22±0.43、1.40±0.56、1.69±0.70、1.53±0.59分）高于中浓度组（0.35±0.38、0.27±0.31、0.42±0.28、0.35±0.33分），差异均有统计学意义（P< 0.05）。3组患者手术前后ODI评分差异均无统计学意义（P＞0.05）。结论0.3%罗哌卡因硬膜外麻醉在经皮椎间孔镜手术中应用效果最好，患者疼痛较轻，且未明显阻滞下肢运动功能，有利于降低手术风险。
Abstract:
ObjectiveTo explore the effect of epidural anesthesia with different concentrations of ropivacaine in percutaneous transforaminal endoscopic surgery.Methods105 patients with lumbar disc herniation who underwent percutaneous transforaminal endoscopic surgery were enrolled and divided into high concentration group, medium concentration group and low concentration group according to the random number table, with 35 cases in each group. The concentrations of ropivacaine used during epidural anesthesia in high, medium, low concentration group were 0.4%, 0.3% and 0.2%, respectively. Heart rate (HR), mean arterial pressure (MAP), visual analogue scale (VAS) and lower limb motor block were observed and compared among the three groups at different time points [before anesthesia (T0), skin incision (T1), expansion of channels (T2), stimulation of nerve roots (T3) and sutures (T4)]. Lower limb motor function was evaluated using the improved Bromage scoring system. The impact of low back pain on daily life was assessed using the Oswestry Disability Index (ODI) before surgery and 1 month after surgery.ResultsThere were significant differences in HR, MAP, VAS and Bromage scores among the three groups at T1-T4. Among them, HR (69.52±7.36, 71.13±7.41, 71.07±6.95, 70.35±7.47 beats/min), MAP (77.41±7.46, 79.34±8.05, 80.25±7.88, 78.37±8.23 mmHg) and VAS score (0.27±0.55, 1.30±0.57, 0.98±0.56, 0.45±0.38 points) in high concentration group, HR (72.43±7.48, 73.76±7.56, 73.42±8.13, 73.66±7.29 beats/min), MAP (83.25±7.62, 84.13±7.92, 82.34±8.29, 81.53±6.94 mmHg) and VAS score (0.41±0.62, 1.56±0.58, 1.23±0.69, 0.52±0.50 points) in medium concentration group were lower than HR(78.65±7.72，80.39±7.60，82.58±7.44，80.91±8.30 beats/min)， MAP(89.55±9.14，92.61±9.40，91.45±9.33，91.81±10.20 mmHg) and VAS score (2.24±0.81，3.74±0.85，4.14±1.10，2.82±0.93 points) in low concentration group. Bromage score in high concentration group (1.22±0.43, 1.40±0.56, 1.69±0.70, 1.53±0.59 points) was higher than that in medium concentration group (0.35±0.38, 0.27±0.31, 0.42±0.28, 0.35±0.33 points)(P<0.05). There was no statistical difference in ODI scores before and after operation among the three groups (P>0.05).ConclusionEpidural anesthesia with 0.3% ropivacaine is the best in percutaneous transforaminal endoscopic surgery, with less pain and no significant block of lower limb motor function, which is beneficial to reduce the risk of surgery.

参考文献/References:

[1]王作伟, 陈赞, 王凯, 等. 经皮椎间孔入路椎间孔镜治疗L5~S1腰椎间盘突出症[J]. 中华医学杂志, 2020, 100(4):270-273.
[2]罗曼, 耿立成, 高涛. 低浓度罗哌卡因硬膜外麻醉在椎间孔镜术中的应用[J]. 中国中西医结合外科杂志, 2019, 25(1):45-48.
[3]中国康复医学会脊柱脊髓专业委员会基础研究与转化学组. 腰椎间盘突出症诊治与康复管理指南[J]. 中华外科杂志, 2022, 60(5):401-408.
[4]Wang H, Zhou TY, Gu YT, et al. Evaluation of efficacy and safety of percutaneous transforaminal endoscopic surgery (PTES) for surgical treatment of calcified lumbar disc herniation: a retrospective cohort study of 101 patients[J]. BMC Musculoskelet Disord, 2021, 22(1): 65.
[5]戴春岗, 谢林, 康然, 等. 动力辅助下经皮全内窥镜结合全可视椎间孔成形术治疗腰椎间盘突出症疗效观察[J]. 医学研究生学报, 2018, 31(10):1050-1053.
[6]王彬, 何鹏, 刘晓伟, 等. 单侧双通道内镜与椎间盘镜治疗腰椎间盘突出症的临床分析[J]. 东南国防医药, 2022, 24(2):142-146.
[7]Sun J, Fang C, Gao F, et al. Comparison of effectiveness and safety between epidural anesthesia vs local anesthesia for percutaneous transforaminal endoscopic discectomy: A systematic review and meta-analysis[J]. Medicine (Baltimore), 2020, 99(1): e18629.
[8]刘辉, 李红, 熊志鹏. 俯卧位低浓度罗哌卡因硬膜外麻醉下椎间孔镜治疗腰椎间盘突出症的临床应用[J]. 中国当代医药, 2021, 28(33):90-93.
[9]赵红卫, 刘丰平, 皮闻森, 等. 腰椎间盘突出症两种脊柱内镜术早期并发症分析[J]. 中国矫形外科杂志, 2021, 29(19): 1729-1733.
[10]Mehta S, Gajbhare MN, Kamble NP. Comparison of Epidural Analgesia Using 0.2% Bupivacaine and 0.2% Ropivacaine for the Management of Postoperative Pain in Major Orthopedic Surgery[J]. Anesth Essays Res, 2018, 12(2): 586-591.
[11]胡荣, 王鑫成, 王媛媛, 等. 罗哌卡因复合芬太尼用于腹腔镜下胃癌根治术后硬膜外自控镇痛效果观察[J]. 临床误诊误治, 2022, 35(2):30-33.
[12]张倩倩, 石翊飒, 张凯, 等. 不同浓度罗哌卡因腰方肌阻滞用于腹腔镜手术患儿术后镇痛的效果[J]. 临床麻醉学杂志, 2021, 37(4):391-394.
[13]Kumari I, Sharma K, Bedi V, et al. Comparison of ropivacaine (0.2%) with or without clonidine 1 μg/kg for epidural labor analgesia: A randomized controlled study[J]. J Anaesthesiol Clin Pharmacol, 2018, 34(1): 18-22.
[14]包代琴, 谢佳, 周艳,等. 单纯罗哌卡因与罗哌卡因联合舒芬太尼用于二次剖宫产术后硬膜外镇痛的效果观察[J]. 重庆医学, 2023, 52(1):61-65.
[15]Hu BW, Li L, Wang HW, et al. Determining the Minimum Effective Concentration of Ropivacaine in Epidural Anesthesia for Tolerable Pain in Transforaminal Percutaneous Endoscopic Lumbar Discectomy to Avoid Nerve Injury: A Double-Blind Study Using a Biased-Coin Design[J]. Drug Des Devel Ther, 2022, 16(2): 315-323.

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更新日期/Last Update: 2023-08-24