【罂粟摘要】超声引导下旁正中穿刺术在老年腰麻患者中的应用

超声引导下旁正中穿刺术在老年腰麻患者中的应用        

贵州医科大学  麻醉与心脏电生理课题组

翻译：张中伟   编辑：潘志军   审校：曹莹

背景：

目前临床上广泛应用的腰麻穿刺技术有两种：正中技术和旁正中技术。这两种方法对于临床医生在面对老年患者时的操作都是相对困难的。本研究的目的是探索一种超声辅助的改良旁正中穿刺技术用于老年患者腰麻的可行性。这将为临床医生提供一种新的、易于操作的新穿刺方法。                   

方法：本研究纳入150名拟在腰麻下行泌尿外科手术的老年患者，随机分为3组(n=50)：(1)正中技术组(M组)；(2)旁正中技术组(P组)；(3)改良旁正中技术组(PM组)。所有的腰麻都由同一位二年级住院医生进行操作。                        

结果：

  与M组和P组相比，PM组首次尝试成功率较高(P<0.05，尤其是65~74岁患者)，尝试次数相对较少(P<0.05)，患者满意度更高(P<0.05)。与M组相比，PM组腰麻操作时间明显缩短(P<0.05)，穿刺次数明显减少(P<0.05)。PM组与P组之间的差异无统计学意义。两组患者术后24 h内低血压发生率、麻醉效果及头痛、腰背痛、恶心呕吐的发生率均无统计学差异。          

结论： 改良的旁正中穿刺技术用于老年患者的腰麻，可显著提高一次穿刺成功率，减少穿刺次数和操作时间，减少操作中组织损伤。与传统技术相比，改进的旁正中技术结合了中路和旁路两种方法的优点，且易于掌握。值得进一步研究和应用。     

原始文献来源：

Wei Zeng, Yisa Shi, Qihui Zheng , et al.Ultrasound-assisted modified paramedian technique for spinal anesthesia in elderly.[J]. BMC Anesthesiol(2022) 22:242

Ultrasound-assisted modified paramedian

technique for spinal anesthesia in elderly

Abstract

Background: At present, there are two techniques which are widely applied clinically; the midline and the paramedian. Both methods are difficult for clinicians when treating the elderly. The aim of this work is to explore the feasibility of an ultrasound-assisted modified paramedian technique for spinal anesthesia in the elderly. This would provide clinicians with a new and easy-to-operate technique.

Methods: A total of 150 elderly patients who were scheduled for urology surgery under spinal anesthesia in our hospital were randomly divided into three groups (n = 50): (i) midline technique group (group M), (ii) paramedian technique group (group P), and (iii) modified paramedian technique group (group PM). All spinal anesthesia were performed by the same second-year resident.

Results: Compared with groups M and P , group PM had significantly higher first-attempt success rate (P < 0.05, especially in patients aged 65-74 years), fewer attempts (P < 0.05), and higher patient satisfaction score (P < 0.05). Compared with group M, the time taken to perform spinal anesthesia and the number of needle redirections were significantly reduced in group PM (P < 0.05). There was no statistically significant difference between groups PM and P . There were also no statistically significant differences in the cases of inconsistency between ultrasound-assisted and landmarkguided location of intervertebral space, the time taken to ultrasound-assisted location, the onset time to pain block at  T10, the incidence of hypotension, anesthesia effect and the incidence of headache, lower back pain, or nausea and vomiting, within 24 h after surgery.

Conclusions: Compared with groups M and P , group PM had significantly higher first-attempt success rate (P < 0.05, especially in patients aged 65-74 years), fewer attempts (P < 0.05), and higher patient satisfaction score (P < 0.05). Compared with group M, the time taken to perform spinal anesthesia and the number of needle redirections were significantly reduced in group PM (P < 0.05). There was no statistically significant difference between groups PM and P . There were also no statistically significant differences in the cases of inconsistency between ultrasound-assisted and landmarkguided location of intervertebral space, the time taken to ultrasound-assisted location, the onset time to pain block at  T10, the incidence of hypotension, anesthesia effect and the incidence of headache, lower back pain, or nausea and vomiting, within 24 h after surgery.

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