手术台高度通过影响穿刺针的视野影响住院医师在腰硬联合麻醉训练中的表现:一项随机对照试验

手术台高度通过影响穿刺针的视野影响住院医师在腰硬联合麻醉训练中的表现:一项随机对照试验

贵州医科大学    麻醉与心脏电生理课题组

翻译:张中伟

编辑：马艳燕   审校：曹莹

目的:本研究的目的是评估手术台高度是否影响住院医师在训练期间实施腰硬联合麻醉的成功率和并发症发生率。

方法：将180例患者按照手术台高度平齐住院医师的脐部(U组)、最低肋缘(R组)、剑突(X组)随机分组，记录腰硬联合麻醉的成功率、感觉异常和血管损伤的发生率。

结果：三组在腰硬联合麻醉的成功率、感觉异常和血管损伤的发生率方面无差异。然而，在硬膜外导管置入过程中，左侧(66.7%)比右侧(33.3%)感觉异常更常见(P = 0.03)。R组患者第三次腰硬联合麻醉成功率(100%)高于第一次(50%;P = 0.01)。大多数住院医师(83%)倾向于在其最低肋骨边缘水平的手术台高度。

结论：住院医师培训时侧卧位腰硬联合麻醉的成功率及并发症均不受手术台高度的影响。然而，当硬膜外导管置入硬膜外腔时，感觉异常更可能发生在左侧。把手术台的高度保持在平齐操作者最低肋缘水平可能会更好。这不仅是大多数住院医师的首选，而且更适合他们进行腰硬联合麻醉训练。

原始文献来源：Juan Gu, Juan Ni, Yushan Ma，et al.The height of the operating table affects the performance of residents in combined spinal and epidural anesthesia training by affecting the vision of the puncture needle: a randomized controlled trial.[J]. BMC Anesthesiology (2023) 23:28

英文原文：

The height of the operating table affects the performance of residents in combined spinal and epidural anesthesia training by affecting the vision of the puncture needle: a randomized controlled trial

Background The present study aimed to evaluate whether the operating table height affected the success rate and incidences of complications of combined spinal-epidural anesthesia administered by residents during training.

Methods One-hundred-and-eighty patients were randomly allocated according to landmarks on the resident’s body: umbilicus (group U), lowest rib margin (R), and xiphoid process (X). The success rates of combined spinal-epi-dural anesthesia, and the incidences of paresthesia and vessel trauma were recorded.

Results There were no differences between the three groups in the success rates of combined spinal-epidural anesthesia, and the incidences of paresthesia and vessel trauma. However, paresthesia during epidural catheter advancement was more common on the left side (66.7%) than the right side (33.3%) (P = 0.03). In group R, the success rate of epidural anesthesia was higher during the residents’ third time (100%) than their first time (50%; P = 0.01). Most residents (83%) preferred the table height at which the needle insertion point was at the level of their lowest rib margin.

Conclusion Neither the success nor the complication of combined spinal-epidural anesthesia in lateral decubitus position during residents’ training affected by the operating table height. However, paresthesia was more likely to occur on the left side when a stiff catheter was inserted into the epidural space. It may be better to keep the table height at residents’ lowest rib margin. It was not just preferred by most of residents but also better for their training of performing epidural anesthesia.

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