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...

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.