腹围和脊柱长度预测蛛网膜下腔阻滞等比重布比卡因剂量的效果

Effect of abdominal girth and vertebral column length on predicting the dose of isobaric plain bupivacaine for spinal anesthesia

目的研究发现能利用腹围和脊柱长度预测达到T_(10)蛛网膜下腔阻滞平面所需等比重0.5%布比卡因剂量,但缺乏临床实践,本研究拟评价该方法预测等比重布比卡因剂量的准确性。方法选择2015年10月—2016年3月嘉兴学院附属第二医院接受蛛网膜下腔阻滞行下肢手术患者200例,ASA分级Ⅰ~Ⅲ级,年龄19~60岁。患者平卧位,在脐平面于呼气末测量患者腹围。患者右侧卧位,背部挺直,测量脊柱长度(骶裂孔至C_7棘突距离)。于L_(3/4)椎间隙行蛛网膜下腔阻滞,采用正中法,25 G蛛网膜下腔阻滞穿刺针,待清亮脑脊液流出表示穿刺成功,穿刺针斜面朝向头端。穿刺成功后按文献中的回归方程给予阻滞平面到达T10所需0.5%等比重布比卡因剂量,注射速度约0.2 ml/s。30 min后测量麻醉阻滞平面。操作中骶裂孔、C_7棘突和L_(3/4)椎间隙均在超声影像下确认。观察记录患者最高痛觉阻滞平面,记录患者年龄、身高、体重、腹围、脊柱长度和布比卡因剂量。结果 198例患者纳入本研究,2例患者因L_(3/4)椎间隙穿刺失败排除。0.5%等比重布比卡因使用剂量(3.2±0.4)ml。痛觉阻滞平面为T_(10)患者159例,占80.3%,最高痛觉阻滞平面为T_8,最低痛觉阻滞平面为T_(12)。结论腹围和脊柱长度与达到T_(10)痛觉阻滞平面所需0.5%等比重布比卡因剂量之间的回归方程能较准确的应用于临床。

Objective Some study shows that abdominal girth and vertebral column length could predict the suitable intrathecal bupivacaine dose for T10 block level to a great extent, but the clinical evidence is lack. This study is to evaluate the accuracy of regression equation between abdominal girth, vertebral column length and the dose of 0.5 % plain bupivacaine for Tl0 block level. Methods Two hundred ASA physical status Ⅰ - Ⅲ patients,aged 19 -65 years,scheduled for lower limbs surgery undergoing spinal anesthesia were enrolled. The patients were placed in the supine position, and at the level of the umbilicus, the abdominal girth was measured at the end of expiration, and the vertebral column length was measured from the C7 vertebra to the sacral hiatus,with the patient placed supine on the operation table. After abdominal girth and vertebral column length obtained,the L3/4 interspace was entered,0.5% plain bupivacaine with room temperature was injected intrathecally at a speed of approximately 2 ml in 10 s when free flow of the cerebrospinal fluid was obtained. The dose of bupivacaine was based on the regression equation expounded in reference. Block level was measured 30 min after spinal anesthesia. The upper block level for loss of pinprick discrimination, age, height, weight, abdominal girth and vertebral column length were recorded. Results A total of 198 patients were enrolled in this study finally. Two patients were excluded from this study because of unsuccessful puncture at L3/4 intervertebral space. The average dose of 0.5% plain bupivacaine was （3.2 ± 0.4）ml. One hundred and fifty-nine cases of patients were with the block level T10, accounted for 80.3% of all patients. The upper block level was Ts ,and the lowest block level was T12. Conclusion The regression equation between abdominal girth, vertebral column length and the dose of 0.5% plain bupivacaine for T10 block level during spinal anesthesia can apply for clinic accurately.