全身麻醉与硬膜外麻醉在经皮椎间孔镜腰椎间盘切除术中的临床疗效对比分析

Comparative Analysis of the Clinical Effects of General Anesthesia and Intraspinal Anesthesia in Percutaneous Endoscopic Foraminal Disc Removal

摘要: 目的：经皮经椎间孔内镜下椎间盘摘除术推荐采用硬膜外麻醉(EA)，但尚未达到满意的疼痛处理。本研究的目的是研究PELD在硬膜外麻醉与全身麻醉(GA)条件下治疗腰椎间盘突出症的临床疗效。方法：根据纳入标准，回顾性筛选2022年1月至2023年2月于新疆医科大学第六附属医院行经皮椎间孔内镜下椎间盘摘除手术的87例患者，根据麻醉方式，将患者分为两组。两组分别为：1) 全身麻醉组(n = 52)；2) 硬膜外麻醉组(n = 35)。回顾两组患者以下变量：两组术前一般资料包括：年龄、性别、病程、身体质量指数、手术节段、合并并发症、吸烟史、既往史、术前VAS评分和术前ODI评分。主要结局指标：手术满意度、Macnab满意度及VAS评分、术后1、3、7、30天VAS评分和术后1、3、7、30天ODI评分。次要结局指标：手术时间、术中出血量、术后住院时间和住院总费用。结果：本研究共纳入87例患者，比较硬膜外麻醉组和全身麻醉组之间的参数。硬膜外麻醉组35例(年龄60.45 ± 10.94)，全身麻醉组52例(年龄61.28 ± 11.77)。1) 术前资料：术前两组患者的年龄、性别、病程、身体质量指数、高血压、糖尿病、冠心病、神经系统、呼吸系统、内分泌系统、全身性疾病、吸烟史和饮酒史指标进行比较，差异均无显著性意义(P > 0.05)；而两组患者手术节段分布的差异有显著性意义(P < 0.05)；2) 主要结局指标：硬膜外麻醉组和全身麻醉组的手术满意度、Macnab满意度相比差异均无显著性意义(P > 0.05)；全身麻醉组术后第1天、3天、1月的腰痛VAS评分明显低于硬膜外麻醉组，差异有显著性意义(P < 0.05)；全身麻醉组术后第1天、3天的腰痛ODI评分明显低于硬膜外麻醉组，差异有显著性意义(P < 0.05)；3) 次要结局指标：硬膜外麻醉组手术时间和住院总费用明显低于全身麻醉组，差异有显著性意义(P < 0.05)。两组患者术后住院时间比较，差异均无显著性意义(P > 0.05)。结论：结果表明，全身麻醉组行经皮内镜下椎间盘切除治疗腰椎间盘的短期临床预后更好，硬膜外麻醉下手术患者的手术时间和住院总费用低于全身麻醉组，而全身麻醉组和硬膜外麻醉组术后体验感基本一致。

Abstract: Background: Percutaneous endoscopic discectomy (PELD) intervertebral intervertebral approach is a technique for the treatment of lumbar disc hernia. It is not certain whether general anesthesia or epidural anesthesia (EA) is more suitable for percutaneous transforaminal endoscopic discation. Objective: Percutaneous epidural (EA) is recommended for endoscopic transforaminal disc, but satisfactory pain management has not been achieved. The purpose of this study is to investigate the clinical efficacy of PELD in the treatment of lumbar intervertebral disc herniation under epidural versus general anesthesia (GA) conditions. Methods: According to the inclusion criteria, 106 patients undergoing percutaneous foraminal endoscopic discectomy from January 2023 to 2 May 2023 were retrospectively screened, and the patients were divided into two groups according to the anesthesia method. Two groups were: 1) general anesthesia group (n = 52) and 2) epidural group (n = 35). The following variables were reviewed in both groups: gender, age, body mass index (BMI), operation time, intraoperative bleeding, postoperative day of hospitalization, surgical section, previous basic medical history, duration, smoking history, drinking history, previous operating room, hospital cost, surgery satisfaction, Macnab satisfaction and VAS score (preoperative, 1 day, 3 days, 7 days and January). Results: A total of 87 patients were included in this study to compare the parameters between the epidural and general anesthesia group. There were 35 patients in the epidural group (age 49.42 ± 14.63) and 52 patients in the general anesthesia group (age 53.78 ± 14.90). 1) Preoperative data: Age, gender, disease duration, body mass index, hypertension, diabetes, coronary heart disease, nervous system, respiratory system, endocrine system, systemic diseases, smoking history and drinking history of the two groups were not significant (P > 0.05); however, the distribution of surgical segments between the two groups was significant (P < 0.05). 2) Postoperative data: operation time, intraoperative blood loss, postoperative hospital stay, surgical satisfaction and Macnab satisfaction were not significant (P > 0.05), the total hospitalization cost of epidural group was significantly lower than that of general anesthesia group, and the difference was significant (P < 0.05). 3) VAS score: No difference in VAS scores between the two groups (P > 0.05); patients in the epidural group had lower VAS scores on days 3, 7, and January than that of the general anesthesia group, the difference was significant (P < 0.05). Conclusion: The results showed that the clinical effect of percutaneous endoscopic lumbar discectomy under epidural anesthesia or general anesthesia was basically consistent, and the overall hospitalization cost and VAS scores of postoperative days 3, 7 and January of the patients under epidural anesthesia were lower than those of the general anesthesia group, and the hospital stay and operation time were shorter.