Kalinin A A, Goloborodko V Yu, Pestryakov Yu Ya, Kundubayev R A, Biryuchkov M Yu, Shchegolev A V, Byvaltsev V A
MD, PhD, Associate Professor, Doctoral Candidate, Department of Neurosurgery and Innovative Medicine; Irkutsk State Medical University, 1 Krasnogo Vosstaniya St., Irkutsk, 664003, Russia; Neurosurgeon, Center of Neurosurgery; Russian Railways-Medicine Clinical Hospital, 10 Botkin St., Irkutsk, 664005, Russia.
PhD Student, Department of Neurosurgery and Innovative Medicine; Irkutsk State Medical University, 1 Krasnogo Vosstaniya St., Irkutsk, 664003, Russia; Head of the Department of Anesthesiology and Resuscitation No.1; Russian Railways-Medicine Clinical Hospital, 10 Botkin St., Irkutsk, 664005, Russia.
Sovrem Tekhnologii Med. 2024;16(3):51-59. doi: 10.17691/stm2024.16.3.06. Epub 2024 Jun 28.
is to assess the effectiveness of a new neuroanesthetic protocol for treating degenerative lumbar spine diseases in high-risk patients.
Two groups of patients with a high risk of anesthesia and surgery determined by the authors' clinical decision support system (CDSS) have been prospectively studied. A new neuroanesthetic protocol was used in the experimental group (EG, n=25), while the control group (CG, n=25) underwent intravenous anesthesia based on propofol and fentanyl. Minimally invasive transforaminal lumbar interbody fusion was performed in all cases. Changes of the intraoperative mean arterial pressure and heart rate, intensity of the local pain syndrome, amount of the opiates used, presence of cognitive disorders, adverse effects of anesthesia, and surgical complications have been compared.
The groups were representative (p>0.05) in terms of the age-gender parameters, anthropological data, comorbid background, involvement in smoking, preoperative characteristics of the lumbar spine, as well as the level of cognitive functions. No statistically significant changes of the mean arterial pressure (p=0.17) were registered in EG patients relative to the CG (p=0.0008). Intraoperative reduction of the heart rate in patients of the CG was not noted (p=0.49) in comparison with the EG (p=0.03). In the postoperative period, the best indicators of cognitive functions on the FAB test (p=0.02) and MoCA test (p=0.03) were revealed in EG. A significantly less amount of perioperative opiates (p=0.005) at a low level of the local pain syndrome was also noted (p=0.01). The intergroup analysis has shown fewer adverse effects of anesthesia in EG compared to CG (p=0.01) with a comparable number of postoperative surgical complications (p=0.42).
A new neuroanesthetic protocol of rendering a specialized care to patients with a high risk of anesthesia and surgery, assessed by the authors-developed CDSS, has resulted in effective elimination of the local postoperative pain syndrome, reduction of perioperative application of opioids, and stabilization of intraoperative indicators of cardiovascular activity. In addition, no postoperative cognitive disorders, anesthetic side-effects, adverse pharmacological consequences of the complex usage of non-steroidal anti-inflammatory drugs, prolonged local anesthetics, alpha-2-agonist, and non-narcotic analgesics have been registered.
旨在评估一种新的神经麻醉方案对高危患者退行性腰椎疾病的治疗效果。
前瞻性研究了两组由作者的临床决策支持系统（CDSS）判定为麻醉和手术高危的患者。实验组（EG，n = 25）采用新的神经麻醉方案，而对照组（CG，n = 25）采用基于丙泊酚和芬太尼的静脉麻醉。所有病例均行微创经椎间孔腰椎椎间融合术。比较了术中平均动脉压和心率的变化、局部疼痛综合征的强度、阿片类药物的使用量、认知障碍的存在情况、麻醉的不良反应以及手术并发症。
两组在年龄 - 性别参数、人体测量数据、合并症背景、吸烟情况、腰椎术前特征以及认知功能水平方面具有代表性（p > 0.05）。与对照组（p = 0.0008）相比，实验组患者的平均动脉压无统计学显著变化（p = 0.17）。与实验组（p = 0.03）相比，对照组患者术中未观察到心率下降（p = 0.49）。在术后期间，实验组在FAB测试（p = 0.02）和MoCA测试（p = 0.03）中认知功能指标最佳。在局部疼痛综合征程度较低时，围手术期阿片类药物的使用量也显著减少（p = 0.005）（p = 0.01）。组间分析显示，与对照组相比，实验组麻醉的不良反应较少（p = 0.01），术后手术并发症数量相当（p = 0.42）。
作者开发的CDSS评估的一种针对麻醉和手术高危患者的新神经麻醉方案，有效消除了局部术后疼痛综合征，减少了围手术期阿片类药物的应用，并稳定了心血管活动的术中指标。此外，未出现术后认知障碍、麻醉副作用、非甾体抗炎药、长效局麻药、α - 2激动剂和非麻醉性镇痛药联合使用的不良药理后果。
