超声横切斜平面扫描行胸段硬膜外穿刺定位

Ultrasound-guided localization for thoracic epidurals by the transverse oblique approach to the thoracic spine

目的评价超声横切斜平面扫描辅助胸段硬膜外穿刺的准确性。方法选择52例拟在胸段硬膜外阻滞下行上腹部手术的患者。采用超声横切斜平面扫描成像(变换角度使成像质量最佳,6MHz凸阵探头)定位脊柱正中线、椎间隙并测量皮肤至硬膜外间隙的距离(超声深度UD),行硬膜外穿刺,记录成功的穿刺点,利用标记有刻度的Tuohy穿刺针和直尺测量经皮肤到达硬膜外间隙的深度(进针深度ND)。通过一致性相关系数分析和95%一致性限Bland-Altman分析来计算UD及ND间的一致性。结果患者UD为(4.82±1.02)cm,ND为(4.71±1.11)cm。超声辅助定位穿刺点成功率为86.5%,61.5%的患者不需调整进针方向。UD与ND之间的一致性相关系数为0.923,95%一致性限为-0.952～0.723cm。结论超声横切斜平面扫描定位胸段硬膜外穿刺点成功率较高,UD与ND的一致性较好。超声横切斜平面扫描法可以为胸段硬膜外穿刺提供可靠的引导。

Objective To assess the accuracy of the transverse oblique approach provided by a ＂single-screen method＂ of ultrasound in identification of the epidural space at the thoracic level. Methods Fifty-two patients requesting thoracic epidural analgesia were enrolled before their upper abdominal surgeries. The midline, intervertebral space and distance from the skin to the epidural space （ultrasound depth/UD） were identified by ultrasound scanning （transverse oblique approach, 6 MHz curved array probe）. During the epidural puncture, the success of the insertion point was recorded, And the distance from the skin to the epidural space was measured by the marked Tuohy needle and a ruler （needle depth/ND）. The concordance between UD and ND was assessed by the concordance correlation coefficient and Bland-Airman analysis with 95% limits of concordance. Results The LID and ND were （4.82± 1.02） cm, （4. 71±1.11） cm, respectively. The success of the insertion point was 86.5%, with no need to redirect the needle in 61.5% of the patients. The concordance correlation coefficient between LID and ND was 0. 923. The 95% limits of concordance were --0. 952-0. 723 crn, Conclusion The transverse oblique approach provided by single-screen method of ultrasound may be a reliable guidance to facilitate thoracic epidural insert.