摘要
目的比较超声辅助定位和传统体表标志定位椎管麻醉在下肢手术老年患者中的穿刺及镇痛效果。方法选取择期行下肢手术的200例老年患者作为研究对象,采用随机数字表法分为超声组(100例)和传统组(100例)。两组均在椎管麻醉下行下肢手术治疗,超声组术中采用超声辅助定位方式,传统组采用传统体表标志定位方式。比较两组穿刺情况、麻醉优良率,术后1 h、6 h、12 h和24 h的疼痛视觉模拟(VAS)评分,术前和术后6 h、1 d、3 d的简易精神状态评价量表(MMSE)评分,以及穿刺不良反应和术后并发症发生情况。结果两组患者的麻醉优良率,术前和术后6 h、1 d、3 d的MMSE评分均无明显差异(χ2=0.23,t分别=0.22、1.88、1.91、0.29,P均>0.05)。但超声组患者的调整穿刺针方向次数、平均穿刺次数和穿刺时间均少于传统组(t分别=15.57、25.52、40.84,P均<0.05),一次穿刺成功率高于传统组(χ2=14.97,P<0.05);超声组术后1 h、3 h的VAS评分均低于传统组(t分别=7.78、4.12,P均<0.05);超声组的腰痛和头痛发生率均低于传统组(P均<0.05)。结论与传统体表标志定位比较,采用超声辅助定位对下肢手术老年患者进行椎管麻醉可减少穿刺次数,缩短穿刺时间,提高穿刺成功率,减少术后腰痛等并发症的发生。
Objective To compare the puncture and analgesia effect between ultrasound assisted localization and tradi-tional body surface marker localization of spinal canal anesthesia in elderly patients undergoing lower extremity surgery.Methods A total of 200 elderly patients undergoing elective lower limb surgery were enrolled as the research objects.According to random number table method,they were divided into ultrasound group(100 cases)and traditional group(100 cases).Both groups underwent lower limb surgery under spinal anesthesia.During surgery,ultrasound group was per-formed with ultrasound-assisted positioning,while traditional group was performed with traditional landmark positioning.The puncture situation,good rate of anesthesia,scores of visual analogue scale(VAS)at 1h,6h,12h and 24h after sur-gery,scores of mini-mental status examination scale(MMSE)before surgery,6h,1d and 3d after surgery,and the inci-dence of adverse puncture reactions and postoperative complications between the two groups were compared.Results There was no significant difference between the two groups in terms of excellent and good anesthesia rate,MMSE scores before operation and 6 hours,1 day and 3 days after operation(χ2=0.23,t=0.22,1.88,1.91,0.29,P>0.05).However,the times of adjusting the direction of the puncture needle,the average times of puncture and the puncture time of the ultra-sound group were less than those of the traditional group(t=15.57,25.52,40.84,P<0.05),and the success rate of one time puncture was higher than that of the traditional group(χ2=14.97,P<0.05).The VAS scores at 1h and 3h after opera-tion of the ultrasound group were lower than those of the traditional group(t=7.78,4.12,P<0.05).The in-cidences of low back pain and headache in ultra-sound group were lower than those in traditional group(P<0.05).Conclusion Compared with traditional body surface marker localization,ultrasound assisted localization for spinal anesthesia in elderly patients undergo-ing lower limb surgery can reduce the number of puncture,shorten
作者
何利方
徐建飞
鲁华荣
姜景卫
吴超
朱龙飞
毛晨俊
HE Lifang;XU Jianfei;LU Huarong(Department of Anesthesi-ology,Jiangshan People's Hospital,Jiangshan 324100,China)
出处
《全科医学临床与教育》
2022年第9期805-809,共5页
Clinical Education of General Practice
基金
江山市指导性科技计划项目(JS2019D023)。
关键词
下肢手术
椎管麻醉
传统体表标志定位
超声辅助定位
麻醉效果
lower limb surgery
spinal anesthesia
traditional landmark positioning
ultrasound-assisted position-ing
anesthesia effect
