地佐辛联合颈神经丛阻滞在老年颈椎间盘切除术中的临床应用效果分析
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摘要
目的比较地佐辛与舒芬太尼联合颈神经丛阻滞在老年颈椎间盘切除术中的临床效果。方法选择2016年1月至2017年7月于本院择期行C_(4~5)或C_(5~6)椎间盘切除术的85例老年患者为研究对象,按照随机数表法将入选患者分为地佐辛组(44例)和舒芬太尼组(41例)。两组患者均行颈神经丛阻滞,地佐辛组患者术前15 min给予地佐辛强化麻醉,舒芬太尼组患者术前15 min给予舒芬太尼强化麻醉。比较两组患者血流动力学指标变化情况、术后视觉模拟评分法(visual analogue scale,VAS)评分变化情况、手术前后血糖和血浆皮质醇水平变化情况以及麻醉不良反应发生率。结果两组患者切皮时、术中及术毕平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)均显著高于本组术前(P_均<0.05),且舒芬太尼组患者切皮时、术中及术毕MAP、HR均显著高于同期地佐辛组(P_均<0.05),两组患者手术前后脉搏血氧饱和度均无显著变化(P_均> 0.05)。术后1 h、4 h、8 h,地佐辛组患者VAS评分均显著低于舒芬太尼组(P_均<0.05)。术毕两组患者血糖、血浆皮质醇水平均显著高于本组术前(P_均<0.05),且术毕舒芬太尼组患者血糖、血浆皮质醇水平均显著高于地佐辛组(P_均<0.05)。舒芬太尼组患者不良反应发生率显著高于地佐辛组(χ~2=4.877,P <0.05)。结论地佐辛联合颈神经丛阻滞用于老年颈椎间盘切除术具有良好的镇痛效果,有助于稳定患者术中血流动力学指标,减轻机体应激反应,无明显不良反应,安全有效。
Objective To compare the clinical effects of cervical plexus block combined with Dezocine and Sufentanil in elderly patients undergoing cervical discectomy. Method From January 2016 to July 2017, 85 elderly patients who underwent selective C4 ~ 5 or C5 ~ 6 discectomy in our hospital were selected as the study subjects, according to the random number table method, the patients were divided into Dezocine group(44 cases) and Sufentanil group(41 cases). Nerve block of cervical plexus was performed in both groups, Dezocine group patients were given intensive anesthesia 15 minutes before operation, Sufentanil group patients were received intensive sufentanil anesthesia 15 minutes before operation. The changes of hemodynamic indexes, visual analogue scale(VAS) scores, blood sugar and plasma cortisol levels before and after operation, and the incidence of adverse reactions to anesthesia were compared between the two groups. Result Mean arterial pressure(MAP) and heart rate(HR) were significantly higher in the two groups at the time of skin incision, during and after operation than those before operation(P_(all)< 0.05), and MAP and HR in Sufentanil group were signi?cantly higher than those in Dezocine group at the same time(P_(all)< 0.05). There were no signi?cant changes in pulse oxygen saturation before and after operation in both groups(P_(all)> 0.05). At 1, 4 and 8 hours after operation, the VAS scores of Dezocine group were signi?cantly lower than those in Sufentanil group(P_(all)< 0.05). The levels of blood sugar and plasma cortisol in the two groups after operation were signi?cantly higher than those before operation(P_(all)< 0.05), and the levels of blood sugar and plasma cortisol in Sufentanil group after operation were signi?cantly higher than those in Dezocine group(P_(all)<0.05).The incidence of adverse reactions in Sufentanil group was signi?cantly higher than that in Dezocine group(χ~2= 4.877, P < 0.05).Conclusion Dezocine combined with cervical plexus block has good analgesic effect in elderly patients undergoing cervical discectomy. It is helpful to stabilize the hemodynamic parameters and reduce the body's stress response. It has no obvious adverse reactions and is safe and effective.
Objective To compare the clinical effects of cervical plexus block combined with Dezocine and Sufentanil in elderly patients undergoing cervical discectomy. Method From January 2016 to July 2017, 85 elderly patients who underwent selective C4 ~ 5 or C5 ~ 6 discectomy in our hospital were selected as the study subjects, according to the random number table method, the patients were divided into Dezocine group(44 cases) and Sufentanil group(41 cases). Nerve block of cervical plexus was performed in both groups, Dezocine group patients were given intensive anesthesia 15 minutes before operation, Sufentanil group patients were received intensive sufentanil anesthesia 15 minutes before operation. The changes of hemodynamic indexes, visual analogue scale(VAS) scores, blood sugar and plasma cortisol levels before and after operation, and the incidence of adverse reactions to anesthesia were compared between the two groups. Result Mean arterial pressure(MAP) and heart rate(HR) were significantly higher in the two groups at the time of skin incision, during and after operation than those before operation(P_(all)< 0.05), and MAP and HR in Sufentanil group were signi?cantly higher than those in Dezocine group at the same time(P_(all)< 0.05). There were no signi?cant changes in pulse oxygen saturation before and after operation in both groups(P_(all)> 0.05). At 1, 4 and 8 hours after operation, the VAS scores of Dezocine group were signi?cantly lower than those in Sufentanil group(P_(all)< 0.05). The levels of blood sugar and plasma cortisol in the two groups after operation were signi?cantly higher than those before operation(P_(all)< 0.05), and the levels of blood sugar and plasma cortisol in Sufentanil group after operation were signi?cantly higher than those in Dezocine group(P_(all)<0.05).The incidence of adverse reactions in Sufentanil group was signi?cantly higher than that in Dezocine group(χ~2= 4.877, P < 0.05).Conclusion Dezocine combined with cervical plexus block has good analgesic effect in elderly patients undergoing cervical discectomy. It is helpful to stabilize the hemodynamic parameters and reduce the body's stress response. It has no obvious adverse reactions and is safe and effective.
引文
[1]李渭敏,杨承祥.地佐辛联合颈丛阻滞用于颈椎间盘切除术的安全性及麻醉效果[J].广东医学,2012,33(5):680-682.
[2]Sindjelic RP,Vlajkovic GP,Lucic M,et al.Incidence of and indications for conversion of cervical plexus block to general anesthesia in patients undergoing carotid surgery:a single center experience[J].J Cardiovasc Surg(Torino),2015,56(3):441-446.
[3]杨晓彬,陈永学,王清香,等.颈丛阻滞联合喉罩全麻对颈椎前路手术应激反应的影响研究[J].现代中西医结合杂志,2015,24(29):3262-3264.
[4]付红梅.小剂量芬太尼复合低浓度左布比卡因在颈丛阻滞的疗效观察[J].海南医学院学报,2013,19(7):996-998.
[5]Calderon AL,Zetlaoui P,Benatir F,et al.Ultrasound-guided intermediate cervical plexus block for carotid endarterectomy using a new anterior approach:a two-centre prospective observational study[J].Anaesthesia,2015,70(4):445-451.
[6]肖福涛,邓忠良.颈椎间盘突出症的手术治疗进展[J].保健医学研究与实践,2015,12(4):81-84.
[7]邵海宇,张骏,杨迪,等.零切迹颈椎前路融合固定系统与传统融合器钢板内固定系统治疗单节段颈椎间盘突出症的病例对照研究[J].中国骨伤,2016,29(6):530-537.
[8]唐勇,王新伟,袁文,等.巨大型颈椎间盘突出症及其手术治疗策略[J].中国矫形外科杂志,2014,22(21):2006-2009.
[9]左文杰,赵秀丽,韩芳,等.颈丛神经阻滞复合右美托咪定在甲状腺手术中的应用效果[J].哈尔滨医科大学学报,2016,50(3):271-274.
[10]章艳君,李榕,刘金柱.不同剂量地佐辛对小儿七氟醚复合麻醉苏醒期躁动的影响[J].重庆医学,2016,8(1):74-76.
[11]贺峰,刘宏飞.地佐辛静脉麻醉联合罗哌卡因局部浸润麻醉在腹腔镜结直肠癌根治术患者恢复期应激反应的影响[J].陕西医学杂志,2018,7(1):20-22.
[12]胡明权,缪冬梅,刘睿,等.右美托咪定对椎管内麻醉手术患者应激反应的影响[J].临床麻醉学杂志,2016,23(3):45-46.
[13]王新辉.不同麻醉深度对老年肠癌手术患者应激反应的影响[J].中国继续医学教育,2016,8(35):68-69.
[14]李朋仙,赵艳.不同麻醉方法对应激反应影响的临床研究进展[J].中国微创外科杂志,2016,16(9):836-840.
[15]巩红岩,郑芳,刘景景,等.超声引导连续胸椎旁神经阻滞镇痛对食管癌手术患者围手术期应激反应的影响[J].中国医师进修杂志,2016,39(5):456.
[16]左文杰,赵秀丽,韩芳,等.颈丛神经阻滞复合右美托咪定在甲状腺手术中的应用效果[J].哈尔滨医科大学学报,2016,50(3):271-274..
[17]周涓.甲状腺手术颈丛神经阻滞麻醉中不同辅助用药的应用效果观察[J].中国实用医药,2016,11(12):169-170.
[18]徐艳,杨文华,吴俊,等.地佐辛注射液对小儿全麻术后的镇痛研究[J].中国临床药理学杂志,2016,32(24):2253-2256.
[19]陈敬锋,许礼旭,陈磊,等.舒芬太尼联合地佐辛对乳腺癌患者术后静脉自控镇痛的临床研究[J].中国临床药理学杂志,2016,32(15):1387-1389.
[20]Demirel S,Torre JA,Bruijnen H,et al.Effect of Superficial Cervical Plexus Block on Baroreceptor Sensitivity in Patients Undergoing Carotid Endarterectomy[J].J Cardiothorac Vasc Anesth,2016,30(2):309-316.
[2]Sindjelic RP,Vlajkovic GP,Lucic M,et al.Incidence of and indications for conversion of cervical plexus block to general anesthesia in patients undergoing carotid surgery:a single center experience[J].J Cardiovasc Surg(Torino),2015,56(3):441-446.
[3]杨晓彬,陈永学,王清香,等.颈丛阻滞联合喉罩全麻对颈椎前路手术应激反应的影响研究[J].现代中西医结合杂志,2015,24(29):3262-3264.
[4]付红梅.小剂量芬太尼复合低浓度左布比卡因在颈丛阻滞的疗效观察[J].海南医学院学报,2013,19(7):996-998.
[5]Calderon AL,Zetlaoui P,Benatir F,et al.Ultrasound-guided intermediate cervical plexus block for carotid endarterectomy using a new anterior approach:a two-centre prospective observational study[J].Anaesthesia,2015,70(4):445-451.
[6]肖福涛,邓忠良.颈椎间盘突出症的手术治疗进展[J].保健医学研究与实践,2015,12(4):81-84.
[7]邵海宇,张骏,杨迪,等.零切迹颈椎前路融合固定系统与传统融合器钢板内固定系统治疗单节段颈椎间盘突出症的病例对照研究[J].中国骨伤,2016,29(6):530-537.
[8]唐勇,王新伟,袁文,等.巨大型颈椎间盘突出症及其手术治疗策略[J].中国矫形外科杂志,2014,22(21):2006-2009.
[9]左文杰,赵秀丽,韩芳,等.颈丛神经阻滞复合右美托咪定在甲状腺手术中的应用效果[J].哈尔滨医科大学学报,2016,50(3):271-274.
[10]章艳君,李榕,刘金柱.不同剂量地佐辛对小儿七氟醚复合麻醉苏醒期躁动的影响[J].重庆医学,2016,8(1):74-76.
[11]贺峰,刘宏飞.地佐辛静脉麻醉联合罗哌卡因局部浸润麻醉在腹腔镜结直肠癌根治术患者恢复期应激反应的影响[J].陕西医学杂志,2018,7(1):20-22.
[12]胡明权,缪冬梅,刘睿,等.右美托咪定对椎管内麻醉手术患者应激反应的影响[J].临床麻醉学杂志,2016,23(3):45-46.
[13]王新辉.不同麻醉深度对老年肠癌手术患者应激反应的影响[J].中国继续医学教育,2016,8(35):68-69.
[14]李朋仙,赵艳.不同麻醉方法对应激反应影响的临床研究进展[J].中国微创外科杂志,2016,16(9):836-840.
[15]巩红岩,郑芳,刘景景,等.超声引导连续胸椎旁神经阻滞镇痛对食管癌手术患者围手术期应激反应的影响[J].中国医师进修杂志,2016,39(5):456.
[16]左文杰,赵秀丽,韩芳,等.颈丛神经阻滞复合右美托咪定在甲状腺手术中的应用效果[J].哈尔滨医科大学学报,2016,50(3):271-274..
[17]周涓.甲状腺手术颈丛神经阻滞麻醉中不同辅助用药的应用效果观察[J].中国实用医药,2016,11(12):169-170.
[18]徐艳,杨文华,吴俊,等.地佐辛注射液对小儿全麻术后的镇痛研究[J].中国临床药理学杂志,2016,32(24):2253-2256.
[19]陈敬锋,许礼旭,陈磊,等.舒芬太尼联合地佐辛对乳腺癌患者术后静脉自控镇痛的临床研究[J].中国临床药理学杂志,2016,32(15):1387-1389.
[20]Demirel S,Torre JA,Bruijnen H,et al.Effect of Superficial Cervical Plexus Block on Baroreceptor Sensitivity in Patients Undergoing Carotid Endarterectomy[J].J Cardiothorac Vasc Anesth,2016,30(2):309-316.