方敏波　邬晓　雷桑　裴铭

[摘要] 目的 比较不同硬膜外麻醉给药方案在椎间孔镜微创手术的麻醉效果。 方法 选取椎间镜治疗腰椎间盘突出髓核摘除术的患者40例，随机分为两组（每组20例）：A组患者硬膜外给予0.25%罗哌卡因10 mL，B组患者硬膜外给予舒芬太尼5 μg和0.25%罗哌卡因10 mL。记录两组患者术前（T0）、手术切皮（T1）、扩张通道（T2）、刺激神经根（T3）、摘除髓核（T4）手术结束（T5）等各时段的血压、心率、VAS评分。并随访记录术后1个月VAS评分，患者满意度以及手术相关并发症。术后疗效满意情况评价采用Oswestry功能障碍指数。 结果 B组患者在T3及T4时间点MAP及HR明显低于A组（P<0.05），B组患者的舒芬太尼用量以及术中VAS评分明显低于A组（P<0.05）。两组患者均未出现手术相关并发症。两组患者术后1个月VAS和ODI评分无明显统计学差异（P>0.05）。结论 在經皮椎间孔镜手术中，硬膜外舒芬太尼复合低浓度罗哌卡因，与单纯罗哌卡因相比能减少静脉镇痛药物用量。

[关键词] 硬膜外；舒芬太尼；椎间孔镜手术；低浓度罗哌卡因

[中图分类号] R614 [文献标识码] B [文章编号] 1673-9701（2018）12-0106-04

Comparison of two epidural dosage regimens in percutaneous transforaminal endoscopic discectomy

FANG Minbo1 WU Xiaolei1 SANG Peiming2 PAN Zhihao1

1.Department of Anesthesiology， Ningbo City Medical Treatment Center Lihuili Hospital， Ningbo 315004，China； 2.Department of Orthopaedics， Ningbo City Medical Treatment Center Lihuili Hospital， Ningbo 315004，China

[Abstract] Objective To compare the anesthetic effects of different epidural anesthetic regimens in percutaneous transforaminal endoscopic discectomy. Methods 40 patients with lumbar disc herniation undergoing percutaneous transforaminal endoscopic discectomy were randomly divided into 2 groups （20 cases in each group）： group A was given 10 ml of epidural 0.25% ropivacaine， group B was given 5 μg of Sufentanil and 10 ml of 0.25% ropivacaine epidurally. The blood pressure， heart rate and VAS score of the two groups were recorded before surgery（T0）， at the time of skin incision （T1）， channel dilation （T2）， nerve roots stimulation （T3）， removal of nucleus pulposus （T4） and at the end of surgery（T5）. The VAS score， patient satisfaction and operation-related complications at 1 month after operation were also recorded. Satisfaction of postoperative curative effect was assessed using Oswestry Disability Index. Results The MAP and HR at T3 and T4 of group B were significantly lower than group A（P<0.05）. The sufentanil dosage and intraoperative VAS scores of group B were significantly lower than group A（P<0.05）. No operation-related complications occurred in either group. There was no significant difference in VAS and ODI scores between two groups 1 month after operation（P>0.05）. Conclusion Compared with ropivacaine alone， epidural sufentanil combined with low concentration of ropivacaine reduced the dosage of intravenous analgesics in percutaneous transforaminal endoscopic discectomy.

[Key words] Epidural； Sufentanil； Percutaneous transforaminal endoscopic discectomy； Low concentration of ropivacaine

椎间孔镜技术因其损伤小、恢复快等优点，在临床上广泛用于治疗腰椎间盘突出症[1，2]。但由于椎间孔区域神经解剖结构较为复杂，为避免神经损伤，满足术中与患者沟通互动，通常选用局部麻醉[3，4]。但局部麻醉镇痛效果较差，患者往往疼痛难以配合手术。研究表明在经皮椎间孔镜治疗腰椎间盘突出手术中，低硬膜外麻醉是安全可行的，其镇痛效果优于局部麻醉，能有效减轻患者术中的疼痛，并且术后患者满意度更高[5，6]，特别是年龄较大患者术中疼痛管理更具优势[7]。另有研究报道，采用鞘内给予舒芬太尼，在椎间孔镜术中应用，效果良好[8]。……