摘要
背景近年来脊柱超声成像逐步显示出其具有辅助硬膜外间隙定位的能力。在本研究中，我们评估了“单屏”超声横切扫描辅助产科硬膜外穿刺的准确性和精密度。方法选择61例拟行硬膜外穿刺的产妇。采用超声成像（横切扫描，2～5MHz凸阵探头）定位脊柱正中线、椎间隙以及皮肤至硬膜外间隙的距离（超声深度，UD）。行硬膜外穿刺时，记录成功的穿刺点，利用标记有刻度的Tuohy穿刺针测量经皮肤到达硬膜外间隙的深度（进针深度，ND）（精确至0．5cm）。通过一致性相关系数分析和95％一致性限Bland-Altman分析来计算UD及ND间的一致性。结果产妇平均年龄33±4．6岁，体重指数29．7±4．8，UD为4．66±0．68cm，ND为4．65±0．72cm。超声辅助定位穿刺点成功率为91．8％，73．8％的患者无需重新调整穿刺方向。UD与ND之间的一致性相关系数为0．881（95％可信区间0．820～0．942）。95％一致性限为-0．666至0．687cm。结论超声定位硬膜外穿刺点成功率较高，UD与ND的一致性非常好。这提示单屏超声横切扫描法可以为产科硬膜外穿刺提供可靠的引导。
BACKGROUND： Ultrasound imaging of the spine has recently been proposed to facilitate identification of the epidhral space. In this study, we assessed the accuracy and precision of the transverse approach, using a ＂single-screen＂ method, to facilitate labor epidurals. METHODS： We enrolled 61 patients requesting labor epidurals. Ultrasound imaging （transverse approach, 2 - 5 MHz curved array probe） identified the midline, the intervertebral space, and the distance from the skin to the epidural space （ultrasound depth/UD）. During the epidural puncture, we recorded the success of the insertion point, and measured the distance to the epidural space to the nearest half-centimeter of the marked Tuohy needle （needle depth/ND）. We calculated the agreement between UD and ND by the concordance correlation coeffident and Bland-Airman analysis with 95% limits of agreement. RESULTS： The average maternal age was 33 ± 4. 6 yr, body mass index 29.7± 4.8, UD 4. 66 ±0. 68 cm, and ND 4.65 ±0. 72 cm. The success of the insertion point was 91.8%, with no need to redirect the needle in 73.8% of the patients. The concordance correlation coefficient between UD and ND was 0. 881 （95% CI 0. 820 - 0. 942）. The 95% limits of agreement were -0. 666 to 0. 687 cm. CONCLUSIONS： We found a good level of success in the ultrasound-determined insertion point, and very good agreement between UD and ND. This suggests that our proposed ultrasound single-screen method, using the transverse approach, can be a reliable guide to facilitate labor epidural insertion.
出处
《麻醉与镇痛》
2008年第3期24-28,共5页
Anesthesia & Analgesia
