标题：多模式镇痛在局麻椎间孔镜下髓核摘除术患者中的应用

      作者：高振意，梁晓初，刘又鹍    北京市中关村医院麻醉科，北京 100080

      卷次： 2020年31卷20期

      【摘要】 目的 探讨多模式镇痛在局麻椎间孔镜下髓核摘除术患者中的应用效果。方法 选取2019年1~6月在北京市中关村医院住院拟行局麻椎间孔镜下髓核摘除术的91例患者为研究对象，按照随机数表法将患者分为观察组46例和对照组45例。观察组给予多模式镇痛，对照组给予局部麻醉。比较两组患者术前(T1)、给药后即刻(T2)、手术切皮时(T3)、手术30 min (T4)、术后2 h (T5)血流动力学中的心率(HR)、平均动脉压(MAP)以及脉搏血氧饱和度(SpO2)；同时比较两组患者的Ramsay镇静评分、视觉模拟评分法(VAS)评分，以及麻醉期间的不良反应情况。结果 两组患者T1的HR比较差异无统计学意义(P>0.05)，而观察组患者在T2~T5时的HR明显低于对照组，差异均有统计学意义(P<0.05)；两组患者在T1、T2时的MAP比较差异均无统计学意义(P>0.05)，而在T3~T5时，观察组患者的MAP明显低于对照组，差异均有统计学意义(P<0.05)；两组患者在T1~T5时SpO2比较差异均无统计学意义(P>0.05)；两组患者在T1、T5时的Ramsay镇静评分比较差异无统计学意义(P>0.05)，而观察组患者T2时的Ramsay评分为(3.44±0.61)分，明显低于对照组的(3.76±0.82)分，T3、T4时 Ramsay镇静评分分别为(2.93±0.71)分、(2.46±0.53)分，明显高于对照组的(2.31±0.56)分、(1.62±0.35)分，差异均有统计学意义(P<0.05)；两组患者在 T1、T2时的VAS评分比较差异均无统计学意义(P>0.05)，而观察组患者在T3、T4、T5时的VAS评分分别为(3.43±0.83)分、(3.74±0.93)分、(3.58±0.89)分，明显低于对照组的(6.87±1.83)分、(6.62±1.65)分、(6.21±1.43)分，差异均有统计学意义 (P<0.05)；观察组患者的不良反应发生率为 13.04%，明显低于对照组的 33.33%，差异有统计学意义 (P<0.05)。结论 局麻椎间孔镜下髓核摘除术中采用多模式镇痛可改善患者的血流动力学，镇静效果良好，安全性高，值得临床推广应用。
      【关键词】 椎间孔镜；髓核摘除术；多模式镇痛；血流动力学；局部麻醉；镇静镇痛
      【中图分类号】 R614.3 【文献标识码】 A 【文章编号】 1003—6350（2020）20—2643—04

Application of multimodal analgesia in percutaneous transforaminal endoscopic discectomy under localanesthesia.
GAO Zhen-yi, LIANG Xiao-chu, LIU You-kun. Department of Anesthesiology, Beijing Zhongguancun Hospital,Beijing 100080, CHINA
【Abstract】 Objective To investigate the application effect of multimodal analgesia in patients undergoing per-cutaneous transforaminal endoscopic discectomy under local anesthesia. Methods Ninety-one patients who were hospi-talized in Beijing Zhongguancun Hospital from January 2019 to June 2019 were selected as the research objects. Accord-ing to random number table method, the patients were divided into observation group (46 cases, receiving multimodal an-algesia) and control group (45 cases, receiving local anesthesia). Heart rate (HR), average arterial pressure (MAP), andpulse oximetry (SpO2) at before surgery (T1), immediately after administration (T2), surgical incision (T3), surgery 30 min(T4), postoperative 2 h (T5) were compared between the two groups, as well as the Ramsay score, Visual AnalogueScale (VAS) score, and adverse reactions during anesthesia. Results There was no significant difference in HR be-tween the two groups at T1 (P>0.05); while the HR of the observation group at T2 to T5 was significantly lower thanthat of the control group (P<0.05). There was no statistically significant difference in MAP between the two groups at T1and T2 (P>0.05); while at T3 to T5, the MAP of the observation group was significantly lower than that of the controlgroup (P<0.05). There was no significant difference in SpO2 between the two groups at T1 to T5 (P>0.05). The Ramsayscores of the two groups at T1 and T5 were not statistically different (P>0.05); while the Ramsay scores at T2 of the ob-