肥胖产妇Tuffier's线的超声评价

Ultrasound assessment of the Tuffier's line in obese parturient

目的:采用超声手段评价体表标志对肥胖孕妇Tuffier's线所经腰椎水平的定位。方法:选择拟在蛛网膜下腔阻滞麻醉下行剖宫产的孕妇90例,首先由一名有丰富椎管内麻醉经验的麻醉主治医生来触摸产妇的双侧髂嵴最高点,决定L_3~L_4间隙的位置并做好标记。由另一名对定位标志不知情,且具有丰富超声医学经验的医生使用超声对产妇进行脊柱扫描,确定L_5~S1间隙直至T_(12)~L_1,并做好标记,对比二者所作标记。结果:经超声扫描确定,分别有34.4%和30%的肥胖产妇Tuffier's线所经腰椎水平为L_4椎体和L_间隙。结论:对于肥胖产妇来说,在行蛛网膜下腔阻滞时通过触摸体表标志来确定Tuffier's线和椎体间隙并不可靠。

Objective To assess the Tuffier＇ s line determined by palpation of the landmarks in obese parturient. Method Ninety cases of obese parturients scheduled for cesarean section under subarachnoid anesthesia were enrolled. At the beginning,an experienced attending anesthesiologist palpated the superior aspects of the iliac crest bilaterally and marked the L3 ~ 4 intervertebral space. Then,another doctor who was blinded to theses markings,performed a spinal ultrasound scan to locate all of the lumbar interspace from L5-S1 to T12~ L1. Upon completion of the scanning,the markings were revealed and compared. Results The percent of the vertebral levels confirmed by palpation at which the Tuffier＇s line intersected the vertebral column in L4 and L3 ~ 4 was 34. 4% and 30% respectively. Conclusion The Tuffier＇ s line determined by palpation is not a reliable anatomical landmark for subarachnoid anesthesia in obese parturients.