不同麻醉下经皮椎间孔镜髓核摘除术治疗腰椎间盘突出症的疗效观察

Therapeutic effect of percutaneous transforaminal nucleus pulposus extraction on lumbar disc herniation under different anesthesia

摘要:

探讨和分析不同麻醉下经皮椎间孔镜髓核摘除术在腰椎间盘突出症（LDH）患者中的临床应用价值。方法?选取2016年1月－2017年12月该院所收治的110例LDH患者作为临床研究对象，采用随机数字表法将入选研究对象随机分为观察组56例和对照组54例，两组患者均行经皮椎间孔镜髓核摘除术治疗，研究组给予腰硬联合麻醉方案，对照组则给予气管插管全麻方案，并分别对两组患者的蒙特利尔认知评估量表（MoCA）、简易精神状态检查量表（MMSE）、视觉模拟评分（VAS）、Oswestry功能障碍指数问卷表（ODI）及临床治疗情况进行比较和分析。结果?观察组术后MoCA评分（28.25±3.94）分和MMSE评分（29.72±4.08）分明显高于对照组，差异均有统计学意义（P <0.05）；术后VAS评分（2.97±0.40）分和ODI指数（20.54±3.16）%明显低于对照组，差异均有统计学意义（P <0.05）；术后临床治疗效果达到优的比率66.07%（37/56），以及总的优良率94.64%（53/56）明显高于对照组，差异有统计学意义（P <0.05）。结论?腰硬联合麻醉下经皮椎间孔镜髓核摘除术对LDH患者认知功能的改善、疼痛症状的缓解和临床治疗效果的提升均有积极的现实意义。

Abstract:

To probe into the clinical application value of therapeutic effect of percutaneous transforaminal nucleus pulposus extraction on lumbar disc herniation under different anesthesia. Methods From January 2016 to December 2017, 110 patients with lumbar disc herniation were selected as clinical research subjects. The selected subjects were randomly divided into observation group (56 cases) and control group (54 cases) by random number table method. The patients with lumbar disc herniation in the two groups were treated with percutaneous transforaminal nucleus pulposus removal. The patients in the study group were treated with combination of lumbar and spinal anesthesia, and the patients in the control group were treated with intubation general anesthesia. The MoCA score, MMSE score, VAS score, ODI index and clinical treatment of the patients in the two groups were compared and analyzed. Results Compared with control group, the MoCA scores (28.25 ± 3.94) points and MMSE scores (29.72 ± 4.08) points in observation group after surgery were increased significantly higher than the control group, the differences were significant statistically (P < 0.05); The VAS scores (2.97 ± 0.40) points and the ODI index (20.54 ± 3.16)% after surgery in observation group were significantly lower than the control group, the differences were significant statistically (P < 0.05); The rate of clinical treatment 66.07% (37/56) and the total excellent rate 94.64% (53/56) after surgery in observation group were significantly higher than control group, the differences were significant statistically (P < 0.05). Conclusion Percutaneous transforaminal nucleus pulposus removal combined spinal and epidural anesthesia has positive and practical significance for the improvement of cognitive function, relief of pain symptoms and improvement of clinical treatment in patients with lumbar disc herniation.