全身麻醉与局部麻醉在经皮椎间孔镜下椎间盘切除术中的临床疗效比较
贵州医科大学 麻醉与心脏电生理课题组
翻译：柏雪 编辑：潘志军 审校：曹莹
目的:局部麻醉（LA）被推荐用于经皮椎间孔内窥镜椎间盘切除术（PTED），但大多无法实现令人满意的疼痛管理。本研究的目的是比较局部麻醉与全身麻醉 (GA) 下 PTED 治疗腰椎间盘突出症的临床疗效。
方法：收集从2018年8月到2020年8月的108名接受PTED治疗的患者临床资料，对临床数据进行回顾性分析。根据麻醉方法分为两组：LA 和 GA，记录患者的一般信息和临床结果，结果包括术前、术后1周、术后1年视觉模拟量表（VAS）和Oswestry功能障碍指数（ODI）。此外，还记录了术后第二天腰痛和腿痛的VAS。
结果：我们将患者分为两组：72名LA患者和36名GA患者。对以下结果进行比较，包括性别、年龄、病程、体重指数、手术分期、手术时间、术中出血、透视时间、住院时间、手术住院总费用、手术满意度、Macnab满意度、并发症、两组患者术前、术后1年腰腿痛VAS及ODI、术后第2天、术后1周腿痛VAS。GA组术后第2天腰痛VAS、术后1周腰痛VAS、ODI均优于LA组（P< 0.05）。但 LA 组总住院费用明显低于 GA 组（P< 0.05）。进一步分析两组年龄可知，中年组（45≤Y≤59）术后第2天背痛VAS、术后1周ODI均有显着差异，老年组术后第2天背痛VAS（Y≥60）（P< 0.05）。然而，两组其他结果之间没有显著差异（P> 0.05）。
结论：LA 和 GA 下 PTED 的长期结果相似，但GA组的短期结果更好，尤其是在中老年患者中。
原始文献来源：
Zhihua Wu , Jiahui He, Huantong Cheng, et, al. Clinical effificacy of general anesthesia versus local anesthesia for percutaneous transforaminal endoscopic discectomy. Frontiers in Surgery, 06 January 2023.
Clinical effificacy of general anesthesia versus local anesthesia for percutaneous transforaminal endoscopic discectomy
Objective: Local anesthesia (LA) is recommended for percutaneous transforaminal endoscopic discectomy(PTED), but satisfactory pain management is not mostly achieved. The goal of this study was to examine the clinical effificacy of PTED for lumbar disc herniation when performed under local anaesthetic vs. general anesthesia (GA).
Methods: From August 2018 to August 2020, the clinical data of 108 patients treated with PTED were retrospectively evaluated and separated into two groups: LA and GA based on the anesthesia method. General information and clinical outcomes of patients were included. Visual analog scale (VAS) and Oswestry disability index (ODI) were recorded before operation, 1 week after operation, and 1 year after operation. In addition, VAS for back pain and leg pain on the second postoperative day were also recorded.
Results: We divided the patients into two groups: 72 in LA and 36 in GA. There were no signifificant differences in gender, age, course of disease, body mass index, surgical segment, duration of operation, intraoperative bleeding, time of flfluoroscopy, length of hospital stay, total hospitalization cost reoperation, surgical satisfaction, Macnab satisfaction, complications, preoperative and 1 year postoperatively VAS for back pain and leg pain and ODI, VAS for leg pain on the second day and 1 week postoperatively between the two groups (P > 0.05). VAS for back pain in GA group on the second day postoperatively, as well as the VAS for back pain and ODI at one week postoperatively, were better than those in LA group (P < 0.05). However, the total hospitalization cost in LA group was signifificantly lower than that in GA group (P < 0.05). Further analysis of different ages in the two groups showed that there were signifificant differences in the VAS for back pain on the second day postoperatively and ODI at 1 week postoperatively in the middle-aged group (45 ≤ Y ≤ 59), as well as the VAS for back pain on the second day postoperatively in the senior group (Y ≥ 60) (P < 0.05).However, therewere no signifificant difference among other groups(P > 0.05).
Conclusion: Long-term outcomes were similar for both PTED under LA and GA, while GA group had better short-term outcomes, especially in middle-aged and elderly patients.
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