超声辅助与盲探穿刺在老年患者蛛网膜下腔阻滞中的比较

The application of ultrasound located and guided subarachnoid block in elderly patients

目的通过应用旁正中纵切超声定位和实时引导技术,探讨此类方法在老年患者旁正中入路蛛网膜下腔阻滞中的应用价值。方法选取拟于蛛网膜下腔阻滞下行下腹或下肢手术的老年患者80例,随机均分为超声组和盲穿组。盲穿组采用传统盲探穿刺法进针,以脑脊液流出确定到达蛛网膜下腔;超声组利用超声技术观察穿刺部位椎间隙情况,并实时引导穿刺针进入蛛网膜下腔。记录试穿次数、穿刺时间、术后腰痛情况。结果与盲穿组比较,超声组的试穿次数明显减少(P<0.05),成功率明显升高(P<0.05),两组穿刺时间及术后腰痛发生率差异无统计学意义。结论老年患者使用超声定位及引导技术行旁正中入路蛛网膜下腔阻滞,可使穿刺定位更加准确,成功率提高。

Objective To evaluate the application value of ultrasound localization and guidance technology used in elderly patients with a paramedian approach for subarachnoid block anesthesia. Methods Eighty elderly patients who underwent lower abdominal or lower limb surgery under subarachnoid anesthesia were selected in the study. All patients were randomized into two groups. One group was ultrasound group and the other was blind puncture group, 40 cases in each group. In the blind puncture group, we used traditional method to puncture, determined the reaching of the subarachnoid by cerebrospinal fluid outflow. In the ultrasound group, we examined the intervertebral space by means of ultrasonic technology, and real-timely guided the needle into the subarachnoid space. The parameters such as the attempting times, the time for the puncture, the occurrence of low back pain of the two positioning methods were recorded. Results The attempting times of ultrasound group was significantly lower than blind group （P〈0.05）, and the success rate was significantly higher than blind group （P〈0. 05）, but the differences of the puncture time and the postoperative low back pain occurrence rate between two groups was not obvious. Conclusion Using the ultrasonic positioning and guiding in the subarachnoid block by the paramedian approach in elderly patients, is more accurate in positioning, and can improve the success rate.