经皮内镜腰椎间盘摘除术中后颈部疼痛与腰段硬膜外腔压力的相关性

目的探讨经皮内镜腰椎间盘摘除术(percutaneous endoscopic lumbar discectomy,PELD)中后颈部疼痛与腰段硬膜外腔压力(lumbar epidural pressure,LEP)的相关性。方法本研究采用前瞻性设计,选择择期经椎板间隙入路PELD患者86例,男46例,女40例,年龄19~71岁,ASAⅠ或Ⅱ级。采用腰段硬膜外麻醉,并经硬膜外导管接换能器连续监测LEP,记录手术开始前LEP基础值(LEPbase)、后颈部开始疼痛时LEP(LEPpain)和术中LEP最大值(LEP_(max)),采用趋势卡方检验分析LEP_(max)与后颈部疼痛发生率的关系。结果有30例(34.9%)患者术中出现后颈部疼痛。LEP_(max)最低为31.0mm Hg,最高为77.0mm Hg。后颈部疼痛患者LEP_(max)为(60.6±8.8)mm Hg,明显高于无疼痛患者的(50.7±9.5)mm Hg(P0.01)。后颈部疼痛的发生与LEP_(max)呈显著正相关(P0.01)。结论经皮内镜腰椎间盘摘除术中腰段硬膜外腔压力最大值越高的患者,后颈部疼痛发生的可能性越大。

Investigation of the correlation between posterior neck pain and lumbar epidural pressure during percuta-neous endoscopic lumbar discectomy

Objective To investigate the correlation between posterior neck pain and lumbar epidural pressure (LEP)during percutaneous endoscopic lumbar discectomy (PELD).Methods A prospective study was performed on 86 patients undergoing PELD,46 males,40 females,aged 1 9-71 years,with ASA physical status of Ⅰ or Ⅱ.Each patient received lumbar epidural anesthesia.Lum-bar epidural pressure (LEP)was monitored continuously through a lumbar epidural catheter which was connected to a pressure transducer.LEP before the operation (LEPbase ),LEP at the time of pos-terior neck pain (LEPpain )and maximal LEP (LEPmax )were recorded.Results Thirty patients (34.9%)complained of posterior neck pain during the procedure.The lowest LEPmax was 31.0 mm Hg,and the highest LEPmax was 77.0 mm Hg.The LEPmax in patients with neck pain [(60.6± 8.8)mm Hg]was significantly higher than LEPmax in patients without neck pain [(50.7 ± 9.5 ) mm Hg](P <0.01 ).Patients with higher LEPmax had higher probabilities of having posterior neck pain (P <0.01).Conclusion Patients with higher LEPmax had higher probabilities of having posterior neck pain.