“把持式”锐角侧入路硬脊膜外腔穿刺应用于肥胖产妇临床分析

Clinical analysis of “Bcs” acute angle epidural cavity puncture by lateral lumbar segment approach on obesity parturient women

目的临床分析硬-腰联合麻醉＂把持式＂锐角侧入路硬脊膜外腔穿刺术在肥胖产妇剖宫产手术中的应用。方法回顾分析2013-02~2014-06肥胖产妇剖宫产、符合以下条件的病例：应用硬-腰联合麻醉,ASA分级Ⅰ-Ⅲ级,体重指数大于30 kg/m2,脊柱无畸形。硬-腰联合麻醉穿刺任何一方累计三次失败病例,改用其它方法穿刺。观察一次穿刺成功例数、穿刺针碰到神经例数、置管是否有阻力脑脊液引流情况。结果统计到符合条件的病例69例,应用穿刺方法：中入路穿刺法（Z组）42例;＂把持式＂锐角侧入路穿刺法（B组）39例,其中12例为Z组腰穿穿刺失败病例,B组没有穿刺失败病例。Z组较B组硬外穿刺碰到神经发生率高（P〈0.05）,腰穿一次成功率低（P〈0.01）;腰穿碰到神经、置管有阻力、脑脊液引流不畅发生率（P〈0.01）。结论 L4-5间隙硬外穿刺,＂把持式＂锐角侧入路硬外穿刺应用于肥胖产妇优于正中入路,值得推广。

Objective To clinical analysis the value of ＂Bcs＂acute angle epidural cavity puncture by lateral lumbar segment approach on obesity parturient women. Methods Review the cases on cesarean section from February 2013 to June 2014 and fit them to the following conditions： used the combined spinal- epidural anesthesia,ASA from I to III,BMI 30 kg / m2,no spinal deformity,3 times failure using other methods. Operators are skilled anesthesiologists and through five years of clinical training. Observation Indexes： the number or rate of cases succeed on first puncture,the number of cases puncture needle encountered nerves,Whether hard to place tube,drainage of cerebrospinal fluid. Results 69 cases were counted,42 cases with epidural cavity puncture by centre lumbar segment approach（ group Z）,39 cases with ＂Bcs＂acute angle epidural cavity puncture by lateral lumbar segment approach（ group B）,12 cases were failure in group Z turned to group B,and no failure cases in group B. Group Z has higher rate on puncture needle encountered nerves than group B（ P〈0. 05）,lower rate of succeed on first puncture（ P〈0. 01）,hard to place tube,drainage of cerebrospinal fluid（ P〈0. 01）. Conclusion ＂Bcs＂acute angle epidural cavity puncture by lateral lumbar segment approach on obesity parturient women better than by center,worthy of promotion.