摘要目的:探究超声引导改良胸腰筋膜间平面阻滞(MTLIP)对腰椎融合术老年患者术后疲劳综合征(POFS)的影响。方法:选取全麻下后路腰椎融合手术患者64例，采用随机数字法分为两组( n＝32)：超声引导下MTLIP组(M组)、对照组(N组)。M组在手术目标最下一个节段腰椎水平线两侧最长肌和髂肋肌之间的胸腰筋膜各注射0.375%罗哌卡因20 ml，N组仅在同样胸腰筋膜位置双侧注射生理盐水20 ml，两组术后均行静脉自控止痛泵(PCIA)。记录两组患者的一般资料、术中舒芬太尼使用量、PCIA有效按压次数、PCIA舒芬太尼使用量；术前1 d(T1)、术后2 h(T2)、术后1 d(T3)及术后3 d(T4)血清肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)浓度；T1、T2、T3、T4时Christensen疲劳评分。采用 t检验，计数资料采用 χ2检验。 结果:与N组比较，M组术中舒芬太尼用量[(57.0±10.0) μg比(67.8±11.7) μg]、术后PCIA有效按压次数[(19.7±6.6)比(36.6±13.4)]、术后PCIA舒芬太尼用量[(39.4±13.2) μg比(73.2±26.8) μg]均较低，差异有统计学意义( t＝-2.271、-6.399、-6.399， P<0.05)。两组在T1时刻的血清TNF-α浓度[(19.7±2.9) ng/L比(20.5±2.3) ng/L]，IL-1β浓度[(4.1±0.3) pg/ml比(4.0±0.3) pg/ml]对比，差异无统计学意义( t＝-1.255、1.200， P>0.05)，在T2、T3、T4时刻与N组比较，M组的血清TNF-α浓度[(26.8±4.5) ng/L比(29.6±4.4) ng/L、(35.9±3.1) ng/L比(37.9±3.9) ng/L、(29.1±2.4) ng/L比(32.0±2.3) ng/L]及IL-1β浓度[(4.5±0.5) pg/ml比(5.9±1.1) pg/ml、(5.5±0.5) pg/ml比(6.8±0.8) pg/ml、(4.7±0.6) pg/ml比(6.0±0.6) pg/ml]均明显降低，差异有统计学意义( t＝-2.729、-2.175、-4.802、-6.905、-7.630、-8.366， P<0.05)。T1时两组Christensen疲劳评分对比[(1.8±0.8)分比(2.0±0.6)分]，差异无统计学意义( t＝-0.713， P>0.05)，T2、T3、T4时与N组比较，M组Christensen疲劳评分[(3.8±1.5)分比(5.0±1.9)分、(3.3±0.5)分比(4.7±1.0)分、(2.7±0.9)分比(3.3±1.3)分]明显降低，差异有统计学意义( t＝-2.724、-6.821、-2.082， P<0.05)。 结论:MTLIP用于腰椎融合术老年患者可以有效改善围术期疼痛，减轻炎性反应，减少POFS发生。

abstractsObjective:To evaluate the effect of ultrasound-guided modified thoracolumbar fascial plane block on postoperative fatigue syndrome in elderly patients undergoing lumbar fusion.Methods:64 patients undergoing posterior lumbar decompression and fusion under general anesthesia were randomly divided into two groups ( n=32): ultrasound-guided MTLIP group (group M) and control group (group N). In group M, 20 ml of 0.375% ropivacaine was injected into the thoracolumbar fascia between the longissimus muscle on both sides of the lumbar horizontal line of the lowest segment of the surgical target. In group N, 20 ml normal saline was injected bilaterally at the same position of thoracolumbar fascia. both groups were treated with intravenous self-control analgesic pump (PCIA). The general data of the two groups were recorded, including the amount of sufentanil used during operation, the number of PCIA effective compressions, and the amount of PCIA sufentanil used; Serum tumor necrosis factor 1 day before operation (T1), 2 hours after operation (T2), 1 day after operation (T3) and 3 days after operation TNF-α and IL-1β Concentration; Christensen fatigue score at T1, T2, T3 and T4. SPSS 24.0 software was used for statistical analysis. The measurement data of normal distribution were expressed by mean±standard deviation ( ± s), t-test was used, and the counting data were used χ2 inspection. Results:Compared with group n, the dosage of sufentanil in group M [(57.0±10.0) μg vs. (67.8±11.7) μg], Postoperative PCIA effective compression times (19.7±6.6 vs. 36.6±13.4), postoperative PCIA sufentanil dosage [(39.4±13.2) μg vs. (73.2±26.8) μg] the differences were statistically significant ( t=-2.271, -6.399, -6.399, P<0.05). At T1, the concentrations of TNF-α and IL-1β in serum in the two groups [(19.7±2.9) ng/L vs. (20.5±2.3) ng/L, (4.1±0.3) pg/ml vs. (4.0±0.3) pg/ml], there were no significant difference in concentration ( t=-1.255, 1.200, P>0.05). AT T2-4, the concentrations of TNF-α and IL-1β in serum of the groupM were lower than the group N, [(26.8±4.5) ng/L vs. (29.6±4.4) ng/L], [(35.9±3.1) ng/L vs. (37.9±3.9) ng/L], [(29.1±2.4) ng/L vs. (32.0±2.3) ng/L], [(4.5±0.5) pg/ml vs. (5.9±1.1) pg/ml], [(5.5±0.5) pg/ml vs. (6.8±0.8) pg/ml], [(4.7±0.6) pg/ml vs. (6.0±0.6) pg/ml], the difference were statistically significant( t=-2.729, -2.175, -4.802, -6.905, -7.630, -8.366, P<0.05). At T1, comparison of Christensen fatigue scores between the two groups[(1.8±0.8) vs. (2.0±0.6)], the difference was not statistically significant( t=-0.713, P>0.05). AT T2-4, the Christensen fatigue score of the group M were lower than group N [(3.8±1.5) vs. (5.0±1.9)], [(3.3±0.5) vs. (4.7±1.0)], [(2.7±0.9) vs. (3.3±1.3)], the difference were statistically significant ( t=-2.724, -6.821, -2.082, P<0.05). Conclusion:MTLIP can effectively improve perioperative pain, reduce inflammatory reaction and reduce POFS in elderly patients undergoing lumbar fusion.