摘要
目的 观察及评价超声引导下竖脊肌平面阻滞(erector spinae plane block)用于骨质疏松性椎体压缩性骨折(OVCF)的疼痛治疗效果。方法 陆军军医大学大坪医院疼痛科收治42例骨质疏松性椎体压缩性骨折患者,男性8例,女性34例;年龄59～86岁,平均75.1岁;BMI 14.5～30.1kg/m~2。采用随机数字表法分为超声引导下竖脊肌平面阻滞组(ESP组)和对照组,每组21例。ESP组采用基础治疗(卧床休息、镇痛和抗骨质疏松药物、物理治疗)结合ESP阻滞;对照组仅采用基础治疗。两组若出现较严重疼痛,疼痛数字评分法(NRS)≥5分,均使用曲马多肌注缓解。评估ESP组患者入院时(T_1)、第4天ESP阻滞前(T_2),阻滞后2h(T_3)、8h(T_4)、第5天(T_5)、第6天ESP阻滞前(T_6)、阻滞后8h(T_7)、第7天(T_8)、出院后21d(T_9)NRS疼痛评分,以及各相同时间对照组患者NRS评分,两组患者第3天、出院后21d匹兹堡睡眠质量指数(PSQI),两组患者第4～7天肌注曲马多需求总次数。结果 ESP组患者行ESP阻滞后NRS评分与入院时、阻滞前比较均下降(P<0.01);出院后21d PSQI与阻滞前比较显著降低(P<0.01)。行ESP阻滞后各时间点NRS评分、曲马多需求量及夜间睡眠质量均显著低于对照组(P<0.05)。结论 采用超声引导下ESP阻滞联合基础治疗显著缓解骨质疏松性椎体压缩性骨折患者的疼痛,改善睡眠质量,减少阿片类药物的应用,治疗效果显著优于单纯基础治疗。
Objective To observe and evaluate the effect of ultrasound-guided erector spine plane(ESP) block on pain management of patients undergoing osteoporosis vertebral compression fracture(OVCF). Methods Forty-two patients with osteoporosis vertebral compression fracture were randomly assigned to ultrasound-guided erector spine plane block group(ESP group=21) and contrast group(C group=21). ESP group received either basic treatment(analgesic drugs,anti-osteoporosis drugs and physiotherapy) with ultrasound-guided erector spine plane block,and contrast group only received basic treatment. The blocks were performed at the 4 th day and 6 th day. Numerical rating scale(NRS) was assessed in the ESP group at the time of admission(T_1),at the 4 th day before ESP block(T_2),2 hours(T_3)and 8 hours(T_4)after block,at the 5 th day(T_5)and 6 th day(T_6) before ESP blocks and at 8 hours after block(T_7),at the 7 th day(T_8)before block,and at the 21 days after discharge(T_9). NRS score was assessed at the same time point in the C group. Pittsburgh sleep quality index(PSQI) was assessed at the 3 rd day and 21 st day after discharge. The times of demands for tramadol hydrochloride injection were recorded at within the 4 th-7 th day. Results ESP group showed significantly lower NRS score at all time points after ESP blocks than pre-block(P<0.01).The decrease of PSQI was obvious at 21 days after discharge than the 3 rd day(P<0.01).ESP group showed significantly lower NRS score,tramadol hydrochloride injection demands and PSQI than C group after block(P<0.05). Conclusion Ultrasound-guided ESP block combined with basic treatment is more effective to relieve pain,improve sleep quality,reduce the dosage of opioids than basic treatment in patients with osteoporosis vertebra compression fracture.
引文
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