中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2008年
30期
12-15
,共4页
可行性研究%颈椎手术,后路%颈神经后支,阻滞麻醉
可行性研究%頸椎手術,後路%頸神經後支,阻滯痳醉
가행성연구%경추수술,후로%경신경후지,조체마취
Feasibility studies%Cervical vertebra surgery,posterior approach%Cervical dorsal rami nerve,block anesthesia
目的 探讨颈神经后支阻滞麻醉用于颈椎后路手术中的有效性和安全性.方法 86例拟行颈椎后路手术的患者,ASA分级Ⅰ～Ⅱ级,随机均分为两组:颈神经后支阻滞麻醉组(Ⅰ组)和局部浸润麻醉组(Ⅱ组).Ⅰ组根据颈神经后支的局部解剖特点,术前通过测量颈椎X线片,确定颈椎关节突关节腰部体表投影点,经皮穿刺阻滞手术切口相对应的双侧脊神经后支而麻醉颈项部;Ⅱ组采用传统的局部浸润麻醉.观察两组术中麻醉效果和麻醉作用时间,对呼吸、血流动力学和SpO2的影响,术后12、24、48 h疼痛评分与镇静评分以及不良反应.结果 Ⅰ组麻醉优率(74%)明显高于Ⅱ组(42%)(P<0.05),Ⅰ组手术时间少于Ⅱ组,但差异无统计学意义(P>0.05);Ⅰ组麻醉药用量明显低于Ⅱ组(P<0.01).两组麻醉后和椎管探查时平均动脉压均升高,且Ⅱ组明显高于Ⅰ组(P<0.05);两组SpO2均>95%;术后24、48 h的VAS Ⅰ组显著低于Ⅱ组(P<0.05);两组无严重麻醉不良反应.结论 颈椎的后路手术施行颈神经后支阻滞麻醉,与其他麻醉方法相比,具有操作简便、麻醉药用量少、麻醉效果确切、对血流动力学影响轻微,降低脊髓及脊神经根损伤几率等优势,是安全可行的.
目的 探討頸神經後支阻滯痳醉用于頸椎後路手術中的有效性和安全性.方法 86例擬行頸椎後路手術的患者,ASA分級Ⅰ～Ⅱ級,隨機均分為兩組:頸神經後支阻滯痳醉組(Ⅰ組)和跼部浸潤痳醉組(Ⅱ組).Ⅰ組根據頸神經後支的跼部解剖特點,術前通過測量頸椎X線片,確定頸椎關節突關節腰部體錶投影點,經皮穿刺阻滯手術切口相對應的雙側脊神經後支而痳醉頸項部;Ⅱ組採用傳統的跼部浸潤痳醉.觀察兩組術中痳醉效果和痳醉作用時間,對呼吸、血流動力學和SpO2的影響,術後12、24、48 h疼痛評分與鎮靜評分以及不良反應.結果 Ⅰ組痳醉優率(74%)明顯高于Ⅱ組(42%)(P<0.05),Ⅰ組手術時間少于Ⅱ組,但差異無統計學意義(P>0.05);Ⅰ組痳醉藥用量明顯低于Ⅱ組(P<0.01).兩組痳醉後和椎管探查時平均動脈壓均升高,且Ⅱ組明顯高于Ⅰ組(P<0.05);兩組SpO2均>95%;術後24、48 h的VAS Ⅰ組顯著低于Ⅱ組(P<0.05);兩組無嚴重痳醉不良反應.結論 頸椎的後路手術施行頸神經後支阻滯痳醉,與其他痳醉方法相比,具有操作簡便、痳醉藥用量少、痳醉效果確切、對血流動力學影響輕微,降低脊髓及脊神經根損傷幾率等優勢,是安全可行的.
목적 탐토경신경후지조체마취용우경추후로수술중적유효성화안전성.방법 86례의행경추후로수술적환자,ASA분급Ⅰ～Ⅱ급,수궤균분위량조:경신경후지조체마취조(Ⅰ조)화국부침윤마취조(Ⅱ조).Ⅰ조근거경신경후지적국부해부특점,술전통과측량경추X선편,학정경추관절돌관절요부체표투영점,경피천자조체수술절구상대응적쌍측척신경후지이마취경항부;Ⅱ조채용전통적국부침윤마취.관찰량조술중마취효과화마취작용시간,대호흡、혈류동역학화SpO2적영향,술후12、24、48 h동통평분여진정평분이급불량반응.결과 Ⅰ조마취우솔(74%)명현고우Ⅱ조(42%)(P<0.05),Ⅰ조수술시간소우Ⅱ조,단차이무통계학의의(P>0.05);Ⅰ조마취약용량명현저우Ⅱ조(P<0.01).량조마취후화추관탐사시평균동맥압균승고,차Ⅱ조명현고우Ⅰ조(P<0.05);량조SpO2균>95%;술후24、48 h적VAS Ⅰ조현저저우Ⅱ조(P<0.05);량조무엄중마취불량반응.결론 경추적후로수술시행경신경후지조체마취,여기타마취방법상비,구유조작간편、마취약용량소、마취효과학절、대혈류동역학영향경미,강저척수급척신경근손상궤솔등우세,시안전가행적.
Objective To probe the validity and security of cervical dorsal rand nerve block in posterior approach of cervical vertebra surgery.Methods Eighty-six adults ASA class I-II patients undergohag posterior approach of cervical spine operation randomized equally to cervical dorsal rami nerve block group (group I )and partial infiltration anesthesia group (group II ).In group I ,according to regional anatomy characteristic of the nerve and by means of preopomtively measuring the cervical vertebra X -ray,the body surface projection of articular process joint waist of cervical vertebra were calibrated.Away 3 cm from latter median line,percutaneous puncture via 45° angle relative into sagittal plane ,adopting long 8 cm 7# needle and anesthetic to block ~e surgical incision corresponding bilateral dorsal rami nerves.In group II,using traditional local infiltration anesthesia.The effect and response time of anesthesia,influence on breathing and hemodynamics or pulse oxygen saturation,visual analogue score( VAS ) and calmed grade postoperatively and adverse reaction were observed and recorded.Results The anesthesia excellent rate (74%) in group I was obviously higher than that(42%) in group II (P ＜ 0.05 ).The surgeries average time in group I was less than that in group II,but no statistical significance (P＞ 0.05).The average dose of anesthetic in group I was obviously lower than that in group II (P ＜ 0.01 ).The mean arterial pressure elevated after anesthesia in both groups,and in group I was significantly lower than that in group lI (P ＜ 0.05 ).The SpO2 of both ＞ 95%.Calmed grade and VAS at 24 and 48 h postoperatively were significantly lower in group I than that in group II (P＜ 0.05).There was no adverse reactions.Conclusions Compared to other anesthesia methods in posterior approach of cervical vertebra surgery,the method of cervical dorsal rami nerve block has so undermentioned dominances: simple,less anesthetic,exact effect of anesthesia,light influence on breathing and hemeodynamies and lower injury of spinal cord or spinal nerve root that the method is safe and feasible.
