艾司氯胺酮预处理后超声引导下骶管阻滞在PELD中的应用效果OA
Application effect of ultrasound-guided caudal block after esketamine pretreatment in PELD
目的 探讨艾司氯胺酮预处理后超声引导下骶管阻滞在经皮内镜下椎间盘摘除术(PELD)中的应用效果.方法 将96例行PELD的腰椎间盘突出症患者随机分为观察组和对照组,各48例.两组患者均采用全身麻醉联合超声引导下骶管阻滞,观察组则先给予艾司氯胺酮预处理后再行超声引导下骶管阻滞.记录两组患者麻醉诱导前(T0)、麻醉诱导后5 min(T1)、手术切皮后30 min(T2)、手术切口缝合结束时(T3)的心率和平均动脉压(MAP);比较两组患者的瑞芬太尼用量、苏醒时间、苏醒后躁动情况;比较两组患者术前和术后24 h的炎症因子水平[C反应蛋白(CRP)、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)]、应激指标[肾上腺皮质激素(ACTH)、皮质醇、乳酸],以及术前、术后24 h和术后48 h的认知功能;记录两组患者不良反应发生情况.结果 两组患者T1、T2、T3的MAP、心率低于T0,且观察组的MAP、心率均高于对照组(P<0.05).观察组的瑞芬太尼用量、苏醒时间、苏醒后躁动发生率、总不良反应发生率少于、短于或低于对照组(P<0.05).两组患者术后血清CRP、IL-6、TNF-α水平及ACTH、皮质醇、乳酸均高于术前,但观察组上述指标低于对照组(P<0.05).两组患者术后24 h、术后48 h的简易精神状态检测表(MMSE)评分低于术前,观察组术后24 h、术后48 h的MMSE评分高于对照组(P<0.05).结论 艾司氯胺酮预处理联合超声引导下骶管阻滞应用于PELD手术中,可降低患者术后炎症反应及应激指标,改善血流动力学稳定性和术后认知功能,且安全性较好.
Objective To investigate the application effect of ultrasound-guided caudal block after esketamine pretreatment in percutaneous endoscopic lumbar discectomy(PELD).Methods A total of 96 patients with lumbar disc herniation undergoing PELD were randomly divided into observation group or control group,with 48 cases in each group.Both groups received general anesthesia combined with ultrasound-guided caudal block,while the observation group received esketamine pretreatment before ultrasound-guided caudal block.Heart rate and mean arterial pressure(MAP)were recorded before anesthesia induction(T0),5 minutes after anesthesia induction(T1),30 minutes after skin incision(T2),and at the end of incision closure(T3).The dosage of remifentanil,recovery time,and post-recovery agitation were compared between the two groups.Inflammatory factor levels in terms of C-reactive protein(CRP),interleukin 6(IL-6),tumor necrosis factor α(TNF-α),stress indicators(adrenocorticotropic hormone[ACTH],cortisol,and lactic acid)before surgery and 24 hours after surgery,as well as cognitive function before surgery,24 and 48 hours after surgery were compared between the two groups.Adverse reactions were recorded in both groups.Results MAP and heart rate at T1,T2,and T3 in both groups were lower than those at T0,and MAP and heart rate in the observation group were higher than those in the control group(P<0.05).The remifentanil dosage,recovery time,incidence rate of post-recovery agitation,and total incidence rate of adverse reactions in the observation group were less,shorter or lower than those in the control group(P<0.05).Postoperatively,levels of serum CRP,IL-6,TNF-α,and ACTH,cortisol,lactic acid in both groups were higher than preoperative indices,but the above indicators in the observation group were lower than those in the control group(P<0.05).The Mini-Mental State Examination(MMSE)scores at 24 and 48 hours after surgery in both groups were lower than preoperative scores,and the MMSE score in the observation group at 24 and 48 hours after surgery was higher than those in the control group(P<0.05).Conclusion The application of esketamine pretreatment combined with ultrasound-guided caudal block in PELD can reduce postoperative inflammatory responses and stress indicators,while improving hemodynamic stability and postoperative cognitive function,with a good safety.
谢梦娇;赵雯昕;丁文平;郑紫晨;侍志斌;贾梦醒
徐州医科大学江苏省麻醉学重点实验室,江苏省 徐州市 221004||徐州医科大学附属医院麻醉科,江苏省 徐州市 221006徐州医科大学江苏省麻醉学重点实验室,江苏省 徐州市 221004||徐州医科大学附属医院麻醉科,江苏省 徐州市 221006徐州市中心医院麻醉科,江苏省 徐州市 221009徐州医科大学江苏省麻醉学重点实验室,江苏省 徐州市 221004||徐州医科大学附属医院麻醉科,江苏省 徐州市 221006徐州医科大学江苏省麻醉学重点实验室,江苏省 徐州市 221004||徐州医科大学附属医院麻醉科,江苏省 徐州市 221006徐州医科大学附属医院麻醉科,江苏省 徐州市 221006
医药卫生
艾司氯胺酮骶管阻滞经皮内镜下椎间盘摘除术腰椎间盘突出症效果
EsketamineCaudal blockPercutaneous endoscopic lumbar discectomyLumbar disc herniationEffect
《广西医学》 2026 (4)
499-504,6
徐州市卫生健康委科技项目(XWKYHT20220088)
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