摘要
目的探讨超声实时引导技术在肥胖患者腰段硬膜外麻醉中的临床应用。方法 86例患者随机分为超声实时引导组(超声组)和传统定位盲探穿刺组(对照组),每组43例。超声组采用超声实时引导进行硬膜外穿刺置管;对照组采用传统的体表解剖标志进针及阻力消失法确定硬膜外间隙。记录两组麻醉前准备时间、穿刺时间、穿刺次数、术中麻醉效果及术后腰痛发生率,超声测量的硬膜外腔的深度与实际穿刺时进针深度。结果两组均成功实施硬膜外穿刺,麻醉效果均能满足手术需要。与对照组比较,超声组穿刺时间明显缩短(P<0.01),穿刺次数明显减少(P<0.05),术后腰痛发生率明显降低(P<0.05)。超声测量的硬膜外腔的深度与实际穿刺时进针深度存在显著正相关关系(r=0.861,P<0.01)。结论超声实时引导技术能提高肥胖患者硬膜外麻醉的质量和满意度,同时避免误伤周围组织,降低术后腰痛发生率,值得在临床推广应用。
Objective To evaluate the role of real-time ultrasound guidance for lumbar epidural anesthesia in obese patients. Methods Eighty-six patients who underwent lower abdomen or lower limb surgery under epidural anesthesia were randomized into two groups. The control group （n = 43） used conventional method which locates the epidural space by surface landmarks and loss-of-resistance （LOR） sensation. The sonography group （n=43） performed the puncture procedure under real-time ultrasound guidance. Respectively, the time of pre-anesthetic preparation, time of operation, attempt times, the effect and complications of anesthesia, the distance between skin to epidural space by ultrasonic measurement and the needle depth were recorded. Results In all 86 patients, the epidural punctures were successfully performed, the anesthesia effect was satisfied for surgery. The time of pre-anesthetie preparation in the sonography group was longer than that of the control group （P〈 0. 01）, while the time of operation was shorter in the sonography group （P〈0, 01）. The attempt times and complications of anesthesia were less in the sonography group （P〈0. 05）. There was significant positive correlation between the depth of the epidural space by ultrasonic measurement and the needle depth（r=0. 861 ,P〈0.01）. Conclusion Epidural anesthesia guided by real-time ultrasound has higher efficacy and safety with less complications and adverse reactions which are directly related to epidural access in obese patients, and it is worthy of clinical application.
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2013年第5期458-460,共3页
Journal of Clinical Anesthesiology
关键词
硬膜外间隙
超声检查
肥胖
Epidural space Ultrasonography Obesity
