摘要目的 探讨颈神经后支阻滞麻醉用于颈椎后路手术中的有效性和安全性.方法 86例拟行颈椎后路手术的患者,ASA分级Ⅰ～Ⅱ级,随机均分为两组:颈神经后支阻滞麻醉组(Ⅰ组)和局部浸润麻醉组(Ⅱ组).Ⅰ组根据颈神经后支的局部解剖特点,术前通过测量颈椎X线片,确定颈椎关节突关节腰部体表投影点,经皮穿刺阻滞手术切口相对应的双侧脊神经后支而麻醉颈项部;Ⅱ组采用传统的局部浸润麻醉.观察两组术中麻醉效果和麻醉作用时间,对呼吸、血流动力学和SpO2的影响,术后12、24、48 h疼痛评分与镇静评分以及不良反应.结果 Ⅰ组麻醉优率(74%)明显高于Ⅱ组(42%)(P<0.05),Ⅰ组手术时间少于Ⅱ组,但差异无统计学意义(P>0.05);Ⅰ组麻醉药用量明显低于Ⅱ组(P<0.01).两组麻醉后和椎管探查时平均动脉压均升高,且Ⅱ组明显高于Ⅰ组(P<0.05);两组SpO2均>95%;术后24、48 h的VAS Ⅰ组显著低于Ⅱ组(P<0.05);两组无严重麻醉不良反应.结论 颈椎的后路手术施行颈神经后支阻滞麻醉,与其他麻醉方法相比,具有操作简便、麻醉药用量少、麻醉效果确切、对血流动力学影响轻微,降低脊髓及脊神经根损伤几率等优势,是安全可行的.

abstractsObjective To probe the validity and security of cervical dorsal rand nerve block in posterior approach of cervical vertebra surgery.Methods Eighty-six adults ASA class I-II patients undergohag posterior approach of cervical spine operation randomized equally to cervical dorsal rami nerve block group (group I )and partial infiltration anesthesia group (group II ).In group I ,according to regional anatomy characteristic of the nerve and by means of preopomtively measuring the cervical vertebra X -ray,the body surface projection of articular process joint waist of cervical vertebra were calibrated.Away 3 cm from latter median line,percutaneous puncture via 45° angle relative into sagittal plane ,adopting long 8 cm 7# needle and anesthetic to block ~e surgical incision corresponding bilateral dorsal rami nerves.In group II,using traditional local infiltration anesthesia.The effect and response time of anesthesia,influence on breathing and hemodynamics or pulse oxygen saturation,visual analogue score( VAS ) and calmed grade postoperatively and adverse reaction were observed and recorded.Results The anesthesia excellent rate (74%) in group I was obviously higher than that(42%) in group II (P ＜ 0.05 ).The surgeries average time in group I was less than that in group II,but no statistical significance (P＞ 0.05).The average dose of anesthetic in group I was obviously lower than that in group II (P ＜ 0.01 ).The mean arterial pressure elevated after anesthesia in both groups,and in group I was significantly lower than that in group lI (P ＜ 0.05 ).The SpO2 of both ＞ 95%.Calmed grade and VAS at 24 and 48 h postoperatively were significantly lower in group I than that in group II (P＜ 0.05).There was no adverse reactions.Conclusions Compared to other anesthesia methods in posterior approach of cervical vertebra surgery,the method of cervical dorsal rami nerve block has so undermentioned dominances: simple,less anesthetic,exact effect of anesthesia,light influence on breathing and hemeodynamies and lower injury of spinal cord or spinal nerve root that the method is safe and feasible.