超声辅助定位在老年脊柱侧弯髋部骨折患者腰-硬联合麻醉中的应用

目的比较超声辅助定位与传统手法定位在老年脊柱侧弯髋部骨折患者腰-硬联合麻醉中的应用效果。方法选择择期腰-硬联合麻醉下行髋部骨折手术的脊柱侧弯患者46例,男9例,女37例,年龄70~101岁,BMI 16~27 kg/m²,ASAⅡ或Ⅲ级。随机分为两组:超声辅助定位组(U组)和传统手法定位组(C组),每组23例。U组利用超声辅助定位,C组采用传统手法定位,均以旁正中位(侧)入路进行穿刺,以硬膜外针阻力消失及腰麻针脑脊液流出确定穿刺成功。记录一次穿刺成功率(不调整穿刺针方向,只通过一个皮肤穿刺点到达蛛网膜下腔的比例)、两次内穿刺成功率、一次皮肤穿刺成功率(不限调整穿刺针方向,通过一个皮肤穿刺点到达蛛网膜下腔的比例)、两次内皮肤穿刺成功率、定位时间、穿刺时间(穿刺针接触患者皮肤到观察到脑脊液流出所用时长)、总时间、实际进针角度、手法定位与超声定位一致率、超声图像质量、患者满意度及麻醉操作中的不良反应和术后24 h内不良反应。结果与C组比较,U组一次穿刺成功率、两次内穿刺成功率和一次皮肤穿刺成功率明显升高,患者满意率明显升高,穿刺时间明显缩短(P<0.05);两组两次内皮肤穿刺成功率和操作总时间差异无统计学意义;手法定位与超声定位一致性为48%,两组麻醉操作过程中及术后24 h内不良反应发生率差异无统计学意义。结论在老年脊柱侧弯髋部骨折患者中,超声辅助定位腰硬联合麻醉可明显提高一次穿刺成功率,减少穿刺次数,缩短穿刺时间。

Application of ultrasound-guided technique in combined spinal-epidural anesthesia for elderly hip fracture patients with scoliosis

Objective To investigate the effect of traditional landmark palpation and preprocedural ultrasound-guided technique of combined spinal-epidural(CSE)anesthesia in elderly hip fracture patients with scoliosis.Methods Forty-six elderly patients with scoliosis scheduled for hip-fracture surgery under CSE anesthesia,including 9 males and 37 females,aged 70-101 years,BMI 16-27 kg/m²,ASA physical statusⅡorⅢ,were randomly allocated into two groups:ultrasound group(group U)and landmark group(group C).Group C used surface landmark palpation to identify the needle insertion point while the group U used ultrasound guidance to identify the point.All the patients were punctured with the paramedian approach.Epidural needle resistance disappearance and cerebrospinal fluid outflow indicated puncture success.The rate of first-pass success,success within two passes,first-attempt success and success in two attempts were gotten,and the number of needle passes and insertion attempts,locating time,puncture time,total time,actual insertion angle,the consistency of traditional landmark palpation and ultrasoundguidance,the quality of ultrasound images,patient satisfaction score,procedural adverse reactions and postoperative complication within 24 hours were recorded.Results Compared with group C,the first-pass success rate,success within two passes rate and first-attempt success rate were significantly increased in group U(P<0.05).Puncture time in group U were lower than those of group C(P<0.05).The consistency between traditional landmark palpation and ultrasoundguidance was 48%.The satisfaction of patients in group U was higher than that in group C.The success in two attempts rate,total time,procedural adverse reactions and postoperative complication within 24 hours between the groups were comparable.Conclusion Pre￣procedural ultrasound-guided technique increases the first-pass success rate,induces the number of needle insertion attempts and puncture time in elderly hip-fracture patient with scoliosis during CSE anesthesia.