摘要
目的探讨单侧双通道脊柱内镜下腰椎融合术中应用Mostcare/PRAM监护仪监测血流动力学变化的准确性及对术后早期恢复的影响。方法回顾性分析2022年9月至2023年9月于河南省直第三人民医院在全身麻醉下行单侧双通道脊柱内镜下腰椎单阶段融合内固定手术118例患者,分为常规麻醉监测组(C组)和Mostcare/PRAM监测组(M组),每组59例。两组均在手术过程中不同时间点:麻醉诱导前(T_(1))、切皮时(T_(2))、椎板减压时(T_(3))、植骨融合时(T_(4))、内固定时(T_(5))、关闭切口时(T_(6))和术毕(T_(7))连续性监测患者基础指标,同时M组在Mostcare/PRAM监护仪下记录患者的外周血管阻力指数(systemic vascular resistance index,SVRI)、每搏量变异度(stroke volume variation,SVV)、心脏指数(cardiac index,CI)、最大压力梯度(maximum pressure gradient,dp/dtmax)以及心脏循环效率(cardiac circulation efficiency,CCE)。评估患者术前1 d和术后24 h、48 h时的15项恢复质量量表评分(Quality of Recovery-15,QOR-15)。记录两组患者术后恢复情况指标和不良反应发生情况。结果M组患者不同时间点Mostcare/PRAM监护仪下血流动力学指标(SVRI、dp/dtmax、SVV、CCE、CI)差异均无统计学意义(P>0.05)。M组患者手术过程中不同时间点心率、CVP、MAP与T1比较差异均无统计学意义(P>0.05)。对比C组,M组患者术后24 h QOR-15评分(98.75±8.69 vs 114.56±12.44,P=0.012)和48 h QOR-15评分(98.75±8.69 vs 114.56±12.44,P<0.001)升高,患者术后首次下床活动时间(35.63±5.88 vs 26.70±4.78,P<0.001)和首次肛门排气时间(12.52±4.22 vs 7.22±3.69,P<0.001)均明显缩短,术后1 d患者VAS评分明显降低(5.02±1.02 vs 3.82±0.89,P<0.001),术后恶心呕吐、心律失常、术后谵妄的发生率均明显降低,差异有统计学意义(P<0.05)。结论相对于传统麻醉手术监护,Mostcare/PRAM监护仪在单侧双通道脊柱内镜下腰椎融合术中可及时准确地监测患者血流动力学的变化,利于患者术后早期恢复和减少术后不良反应发生。
Objective To assess the accuracy of hemodynamic changes monitored by the Mostcare/PRAM monitor during spinal fusion internal fixation surgery and its impact on early prognosis.Methods A retrospective analysis was conduc-ted on 118 patients who underwent unilateral two-channel lumbar single-stage fusion and internal fixation surgery un-der general anesthesia at Third Peoples Hospital of Henan Province from September 2022 to September 2023.They were divided into the traditional surgical anesthesia monitoring group(group C)and the Mosteare/PRAM monitor group(group M).Both groups continwously monitored the basic monitoring indicators of patients before anesthesia induction(T_(1)),during skin incision(T_(2)),during laminectomy(T_(3)),during bone graft fusion(T_(4)),during internal fixation(T_(5)),during incision closure(T_(6))and at the end of surgery(T_(7))at different time points during the surgical process,and at the same time,the M group recorded the systemic vascular resistance index(SVRI),stroke volume variation(SVV),cardiac index(CI),maximum pressure gradient(dp/dtmax),and cardiac circulation efficiency(CCE)of patients under the Mostcare/PRAM monitor.The early recovery quality(QOR-15)of patients was evaluated on day 1 before surgery and at 24 and 48 hours after surgery.The postoperative recovery indicators and incidence of adverse reactions were recorded in two groups of patients.ResultsThere was no statistically significant difference in the hemodynamic indicators(SVRI,dp/dtmax,SVV,CCE,CI)under Mostcare/PRAM monitor at different time points among patients in group M(P>0.05).Compared with T1time point,there was no significant difference in the heart rate,CVP,MAP at different times during the operation in group M(P>0.05).Compared with group C,patients in group M showed an increase in QOR-15 scores at 24 hours(98.75±8.69 vs 114.56±12.44,P=0.012)and 48 hours(98.75±8.69 vs 114.56±12.44,P<0.001)after surgery,a significant reduction in the first time for patients to get out of bed(35.63±5.88 vs 26.70±4.78,P<0.001)and the first time for anal exhaust(12.52±4.22 vs 7.22±3.69,P<0.001)after surgery,a significant decrease in VAS scores(5.02±1.02 vs 3.82±0.89,P<0.001)on day 1 after surgery,and a significant decrease in the incidence of postoperative nausea,vomiting,arrhythmia,and delirium(P<0.05).Conclusion Compared to traditional anesthesia surgery monitoring,the Mostcare/PRAM monitor can timely and accurately monitor changes in patient hemodynamics during UBE lumbar fusion surgery,which is beneficial for early postoperative recovery and reduces the occurrence of postoperative adverse reactions.
作者
王琦英
申明奎
张江峰
刘定国
郭晓辉
钱晓岚
WANG Qi-ying;SHEN Ming-kui;ZHANG Jiang-feng;LIU Ding-guo;CUO Xiao-hui;QIAN Xiao-lan(Department of Anesthesiology,the Third Peoples Hospital of Henan Province,Zhengzhou,Henan 450016,China;Department of Minimally Invasive Spinal Surgery,the Third Peoples Hospital of Henan Province,Zhengzhou,Henan 450016,China)
出处
《医药论坛杂志》
2025年第15期1608-1613,共6页
Journal of Medical Forum
基金
河南省医学科技攻关计划联合共建项目(LHGJ20230663)。
