Objective To observe the clinical effects of different anesthesia methods for minimally invasive improved transforaminal lumbar interbody fusion (TLIF) in the treatment of degenerative diseases, in order to explore the better anesthesia method. Methods In the early stage, 51 patients were divided into early stage group 1 (combined lumbar and epidural anesthesia) and early stage group 2 (general anesthesia). The anesthesia success rate, muscle relaxant score, postoperative determination of lower limb function and postoperative VAS score of the two groups were compared. In the late stage of study, based on the study results of the early stage, 158 patients were divided into late stage group 1 (did not give blood conservation) and late stage group 2 (given blood conservation). The HR, SPO2, MAP, postoperative VAS score, postoperative awakening extubation time, intraoperative blood loss and allogeneic blood transfusion volume of the two groups were monitored. Results The anesthesia success rate of early stage group 1 was significantly lower than that of early stage group 2 (P < 0.05). Early stage group 1 and early stage group 2 were different in the muscle relaxant score, postoperative determination of lower limb function and postoperative VAS score, with statistical significance (P < 0.05). The intraoperative blood loss and allogeneic blood transfusion volume of late stage group 2 were significantly smaller than those of late stage group 1 (P < 0.01). 20 minutes after surgery, the two groups were significantly different in the MAP value (P < 0.05). Late stage group 1 and late stage group 2 were not significantly different in HR, SPO2, postoperative VAS score and postoperative awakening extubation time (P > 0.05). Conclusion Intubation general anesthesia has the advantages of high success rate, complete muscle relaxation and good safety in the minimally invasive improved TLIF in the treatment of degenerative diseases, thus it can serve as the preferred anesthesia method for the surgery. Active implementation of intraoperative blood conservation measure can effectively reduce intraoperative blood loss, which is an important way to improve anesthesia safety.%目的 观察微创改良经椎间孔椎体间融合术(TLIF)治疗腰椎退行性疾病时不同麻醉方法 的临床效果,分析并探讨较佳的麻醉方案.方法 将研究初期51例患者分为初期1组(腰硬联合麻醉)和初期2组(全麻),对比两组麻醉成功率、肌松评分、术后判定下肢功能时间和术后视觉模拟评分(VAS);研究后期158例患者基于初期研究结果 均行全麻,分为后期1组(不行血液保护),和后期2组(行血液保护),监测两组心率(HR)、血氧饱和度(SPO2)、平均动脉压(MAP)、术后VAS评分、术毕至清醒拔管时间和术中出血量及异体输血量.结果 初期1组的麻醉成功率显著低于初期2组(P < 0.05),比较初期1组和初期2组的肌松评分、术后判定下肢功能时间和术后VAS评分,差异均有统计学意义(P < 0.05).后期2组的术中出血量及异体输血量显著少于后期1组(P < 0.01);手术开始后20 min,两组MAP值比较,差异有统计学意义(P < 0.05);比较后期1组和后期2组的HR、SPO2、术后VAS评分、术毕至清醒拔管时间,差异均无统计学意义(P > 0.05).结论 气管插管全麻用于微创改良TLIF治疗腰椎退行性疾病,具有成功率高、肌松完全、安全性好等优点,可作为该术式的优选麻醉方式;术中积极实施血液保护措施,能有效减少术中出血,是提高麻醉安全性能的重要手段.
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