2种骶裂孔穿刺方法的骶管麻醉效果比较

Comparison of two methods of sacral hiatus puncture for sacral canal anesthesia

目的探索B超定位引导骶裂孔穿刺法和传统体表定位法穿刺骶管麻醉的成功率与并发症。方法选取该院肛肠科和泌尿外科97例会阴部手术患者,随机分为两组,观察组(B超定位)51例,对照组(传统方法)46例。观察组采取线性高频B超探头纵横十字交叉法定位。探及骶裂孔后,将纵置的探头下部置于骶裂孔上方,采用声场内平面技术,将注射针头经超声探头下缘,与皮肤呈45°角缓慢进针。根据超声实时显像图像,引导和调整穿刺方向及深度,直至针尖完全位于骶管腔中。对照组采取传统体表定位法穿刺。结果观察组一次穿刺成功率、血管损伤率、穿刺次数及穿刺时间与对照组比较,差异有统计学意义(P<0.05)。观察组1例穿刺失败,是因为初次实施B超定位穿刺时,未注意避开静脉丛,导致血管损伤。结论 B超引导下骶管麻醉,不但大大提高穿刺成功率,而且节约操作时间,减少穿刺次数,减少血管损伤并发症,有很好的临床推广应用价值。

Objective To explore the success rate and complications of percutaneous puncture of sacralcanal guided by B ultrasound.Methods Ninety-seven patients receiving perineal surgery in the AnorectalDepartment and Department of Urology were randomly divided into observation group(B ultrasound positioninggroup,51cases)and control group(traditional method group,46cases).The observation group adopted thelinear high-frequency ultrasound probe cross positioning method.The lower part of the longitudinal probe wasarranged at the upper part of the sacral hiatus.Using the inner plane technique of the acoustic field,theinjection needle was slowly inserted along the lower edge of the ultrasonic probe at a45degree angle withthe skin.The direction and depth of the puncture were guided and adjusted according to the ultrasound realtimeimage,until the needle tip was completely located in the sacral lumen.The control group was treatedwith the traditional method of body surface localization.Results The1puncture success rate,the averagenumber of puncture,the average puncture time and the blood vessel injury rate in the observation group weresignificantly different from those in the control group(P<0.05).In the observation group,1case had failurein1puncture,because the operator did not pay attention to avoid venous plexus at the initial implementationof B ultrasound positioning,resulting in vascular injury.Conclusions Ultrasound guided sacral canalanesthesia,not only greatly improves the success rate of puncture,but also saves the operating time andreduces the number of puncture and the complications of vascular injury,and has good clinical applicationvalue.