超声定位在肥胖产妇腰硬联合麻醉穿刺的应用研究

Study on the application of ultrasound localization in the puncture of combined spinal and epidural anesthesia for obese parturient

目的评价超声定位腰椎间隙在肥胖产妇腰硬联合麻醉穿刺中的临床应用效果。方法择期行剖宫产手术的足月妊娠产妇60例,体重指数≥30 kg/m^2,随机分为对照组和超声组,每组30例。记录两组产妇的年龄、身高、体重、孕周、定位时间、穿刺次数、穿刺成功时间,记录麻醉操作过程中出现神经刺激征象、硬膜外置管出血、硬膜穿破后头痛及麻醉后腰背痛例数。结果与对照组相比,超声组定位时间显著延长,一次成功率显著提高,穿刺成功所需时间显著缩短,差异有统计学意义(P<0.05)。超声组神经刺激征象、硬膜外置管出血及麻醉后腰背痛例数明显少于对照组,差异有统计学意义(P<0.05)。结论超声定位腰椎间隙有利于提高肥胖产妇腰硬联合麻醉一次穿刺成功率,减少麻醉穿刺时间及麻醉穿刺相关并发症。

Objective To evaluate the clinical effect of ultrasound localization of lumbar space in the puncture of combined spinal and epidural anesthesia for cesarean section of obese women.Methods Sixty full-term pregnant women with body mass index≥30 kg/m^2 were randomly divided into the control group and ultrasound group with 30 cases in each group.The age,height,weight,gestational weeks,localization time,puncture times and successful puncture time of the two groups were recorded.The symptoms of nerve stimulation,bleeding of epidural catheter,headache after dural puncture and backache after anesthesia were recorded.Results Compared with the control group,the localization time of ultrasound group was significantly longer,the success rate of combined spinal and epidural anesthesia performed by one puncture was significantly improved,and the successful puncture time was significantly shorter(P<0.05).The number of cases of nerve stimulation,epidural bleeding and backache after anesthesia in the ultrasound group was significantly lower than in the control group(P<0.05).Conclusion Ultrasound localization of lumbar space is helpful to improve the success rate of one-time puncture of combined spinal and epidural anesthesia in obese women,reduce the time of puncture and the incidence of complications related to puncture.