体表标志引导和实时超声引导硬膜外置管在儿童人群中比较：一项前瞻性随机对照试验

体表标志引导和实时超声引导硬膜外置管在儿童人群中比较：一项前瞻性随机对照试验

贵州医科大学  麻醉与心脏电生理课题组

翻译：安丽  编辑：张中伟   审校：曹莹

  0 1 背景

在小儿患者实施硬膜外置管对麻醉医师具有一定的技术挑战。在实时超声引导下实施硬膜外置管已显示出应用前景。在儿童人群中，我们应用体表标志引导和实时超声引导硬膜外置管进行了比较。

  0 2 方法

在本项前瞻性、随机、比较试验中，共纳入45例1-6岁接受腹部和胸部手术的儿童患者。采用计算机生成的随机数字表法将45例患儿随机分为两组，采用封闭不透明法进行分组，分别为体表标志引导组(LT组)和实时超声引导组(UT组)实施硬膜外置管。主要结果是比较硬膜外置管操作时间(不包括超声探头准备时间)。次要结果是比较两组的穿刺次数(重新插入针头)、骨质接触、针头定向、使用超声监测皮肤到硬膜外的距离、并记录穿刺置管的成功率和并发症。

  0 3 结果

LT组到达硬膜外间隙的时间中位数为105.5（297.0）秒，UT组为143.0（150）秒（P=0.407）。而UT组的首次穿刺成功率更高(UT组87.0% vs. LT组40.9%;P = 0.004)，骨质接触次数、穿刺针重定向次数和手术相关并发症均显著降低。

0  4 结论  

实时超声引导下硬膜外置管显著减少了穿刺针的重新定位、穿刺次数、骨质接触和并发症。在穿刺针进入硬膜外间隙的时间比较，体表标志引导组和实时超声引导组之间在统计学上没有显著差异。

0  5 原始文献来源  

Tanya Mital, Manoj Kamal, Mritunjay Kumar, Rakesh Kumar, Pradeep Bhatia, and Geeta Singariya. Comparison of landmark and real-time ultrasound-guided epidural catheter placement in the pediatric population: a prospective randomized comparative trial.Anesth Pain Med 2021;16:368-376.Doi.org/10.17085/apm.21035.

英文原文

Comparison of landmark and real-time ultrasound-guided epidural catheter placement in the pediatric population: a prospective randomized comparative trial

Abstract

Background: Epidural block placement in pediatric patients is technically challenging for anesthesiologists. The use of ultrasound (US) for the placement of an epidural catheter has shown promise. We compared landmark-guided and US-guided lumbar or lower thoracic epidural needle placement in pediatric patients.

Methods: This prospective, randomized, comparative trial involved children aged 1–6 years who underwent abdominal and thoracic surgeries. Forty-five children were randomly divided into two groups using a computer-generated random number table, and group allocation was performed by the sealed opaque method into either landmark-guided (group LT) or real-time ultrasound-guided (group UT) epidural placement. The primary outcome was a comparison of the procedure time (excluding US probe preparation). Secondary outcomes were the number of attempts (re-insertion of the needle), bone contacts, needle redirection, skin-to-epidural distance using the US in both groups, success rate, and complications.

Results: The median (interquartile range) time to reach epidural space was 105.5 (297.0) seconds in group LT and 143.0 (150) seconds in group UT (P = 0.407). While the first attempt success rate was higher in the UT group (87.0% in UT vs. 40.9% in LT; P = 0.004), the number of bone contacts, needle redirections, and procedure-related complications were significantly lower.

Conclusions: The use of US significantly reduced needle redirection, number of attempts, bone contact, and complications. There was no statistically significant difference in the time to access the epidural space between the US and landmark technique groups.

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