| 摘要: |
| 目的 通过回顾性队列研究，探究围手术期加速康复外科（ERAS）理念指导下脊椎麻醉与全身麻醉对微创经椎间孔腰椎椎体间融合术（MIS-TLIF）患者围手术期指标的影响。方法 回顾性分析2019年1月至2021年12月成都大学附属医院行MIS-TLIF治疗的40例患者的围手术期资料，其中行脊椎麻醉与全身麻醉的患者各20例。收集每位患者的手术时间、术中不良事件、术后不良事件、术后住院时间、麻醉后监测治疗室（PACU）中3 h内数值评定量表（NRS）疼痛评分、阿片类药物使用情况、术后初次下床活动时间等，比较两组间的差异。结果 两组患者的一般资料差异均无统计学意义（P均＞0.05）。与全身麻醉组相比，脊椎麻醉诱导后接受MIS-TLIF治疗患者的总手术室时间少［（192.18±18.09） min vs（223.22±19.54） min，P＜0.001]，离开手术室时间少［（5.44±1.95） minvs （9.94±1.28） min，P＜0.001]，术中平均心率低［（67.39±7.44） min-1 vs（72.94±8.61） min-1，P=0.035]，术中平均动脉压低［（78.38±9.88） mmHg vs（84.47±8.30） mmHg，P=0.041]（1 mmHg＝0.133 kPa），PACU中3 h内NRS疼痛评分低［（3.81±1.87）分vs（5.43±2.24）分，P=0.017]，PACU中3 h内阿片类镇痛药物（硫酸吗啡）需求量少［（5.36±1.71） mg vs（7.22±2.01） mg，P=0.003]，术后第1次使用镇痛药时间晚［（58.11±20.19） minvs（45.58±17.16） min，P=0.041]，术后初次下床活动时间早［（430.77±122.38） min vs（843.86±95.44） min，P＜0.001]。两组间总手术时间、术中出血量、术后住院时间的差异均无统计学意义（P均＞0.05）。结论 在ERAS理念指导下，MIS-TLIF手术可选择脊椎麻醉，其能有效减少手术室时间和术后疼痛，并能早期术后活动。 |
| 关键词: 脊椎麻醉 全身麻醉 微创手术 经椎间孔腰椎椎体间融合术 加速康复外科 |
| DOI：10.16781/j.CN31-2187/R.20220308 |
| 投稿时间：2022-04-16修订日期：2022-12-22 |
| 基金项目:国家重点研发计划（2019YFB1311403）. |
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| Application of enhanced recovery after surgery concept in anesthetic management of patients undergoing minimally invasive transforaminal lumbar interbody fusion |
| CHEN Yong,WANG Xiong,WANG Liangzhong,ZHANG Bixin,LI Kainan* |
(Department of Anesthesiology, Affiliated Hospital of Chengdu University, Chengdu 610036, Sichuan, China
*Corresponding author) |
| Abstract: |
| Objective To explore the effects of spinal anesthesia (SA) and general anesthesia (GA) under the guidance of enhanced recovery after surgery (ERAS) concept on minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) through a retrospective cohort study. Methods Perioperative data of 40 patients who underwent MIS-TLIF in The Affiliated Hospital of Chengdu University from Jan. 2019 to Dec. 2021 were retrospectively analyzed, with 20 patients in the SA group and 20 in the GA group. The operative time, intraoperative adverse events, postoperative adverse events, postoperative hospital stay, numeric rating scale (NRS) pain score within 3 h in post-anesthesia care unit (PACU), opioid use, and the time from admission to the first mobilization of patients were collected, and the differences between the 2 groups were compared. Results There were no significant differences in the general data between the 2 groups (all P＞0.05). Compared with the GA group, patients receiving MIS-TLIF in the SA group had shorter total operating room time ([192.18±18.09］min vs[223.22±19.54］min, P＜0.001), shorter time to leave operating room ([5.44±1.95］min vs[9.94±1.28］min, P＜0.001), lower mean intraoperative heart rate ([67.39±7.44］min-1 vs[72.94±8.61］min-1, P=0.035), lower mean intraoperative arterial pressure ([78.38±9.88］mmHg vs[84.47±8.30］mmHg, P=0.041) (1 mmHg＝0.133 kPa), lower NRS pain score within 3 h in PACU ([3.81±1.87］points vs[5.43±2.24］points, P=0.017), lower dose of opioid analgesics (morphine sulfate) within 3 h in PACU ([5.36±1.71］mg vs[7.22±2.01］mg, P=0.003), later time of the first use of analgesics after operation ([58.11±20.19］min vs[45.58±17.16］min, P=0.041］, and earlier time from admission to the first mobilization [(430.77±122.38］min vs[843.86±95.44］min, P＜0.001］. There were no significant differences in total operation time, intraoperative blood loss, or postoperative hospital stay between the 2 groups (all P＞0.05). Conclusion AS can be used for MIS-TLIF operation under the guidance of ERAS concept, and it can effectively reduce the operating room time and postoperative pain, also with an earlier return to normal activities. |
| Key words: spinal anesthesia general anesthesia minimally invasive surgery transforaminal lumbar interbody fusion enhanced recovery after surgery |
