手持式超声仪测量硬膜外腔深度的准确性研究

Accuracy of handheld ultrasound device in measuring depth of epidural space

目的评估在硬膜外麻醉中手持式超声仪(Accuro)测量硬膜外腔深度与传统阻力消失法测量硬膜外腔深度的一致性。方法收集2019年6月1日-7月31日于解放军总医院第一医学中心行急诊剖宫产手术的产妇40例。所有产妇均采用硬膜外麻醉方法进行麻醉。首先用手持式超声仪测量其硬膜外腔深度(Accuro depth,AD),然后用阻力消失法进行硬膜外穿刺,同时使用穿刺针测量穿刺的实测深度(needle depth,ND)。采用配对样本t检验、Pearson法以及Altman-Bland法对手持式超声仪的测量深度与实测穿刺深度的一致性和相关性进行分析。结果手持式超声仪测得的硬膜外腔平均深度为(4.23±0.73)cm,实际穿刺测得的平均深度为(4.70±0.96)cm。配对样本t检验显示,ND与AD的差值为(0.56±0.09)cm,二组差异有统计学意义(P<0.05);Person相关性分析显示,AD与ND的相关系数0.808(P<0.05),二者具有较强的相关性;Bland-Altman一致性分析显示,有5.13%(2/39)的点在95%CI范围以外,表明AD与ND的一致性较高(94.87%,P<0.05)。结论手持式超声仪预测所得的硬膜外腔深度与实测穿刺深度具有较好的相关性与一致性,可以用来指导硬膜外麻醉。

Objective To evaluate the consistency of Accuro's measurement of the epidural depth in epidural anesthesia with the traditional resistance loss method.Methods From June 1,2019 to July 31,2019,40 pregnancies undergoing cesarean section in our center were enrolled and all the general information were recorded.The epidural depth was measured with Accuro(AD),then the epidural puncture was performed with the disappearance of resistance method to get the actual depth of the needle(ND).The two variables were analyzed by paired t test,Pearson correlation analysis and Altman-Bland consistency analysis.Results There was significant difference between AD and ND by paired t test([4.23±0.73]cm vs[4.70±0.96]cm,P<0.0001).In the Pearson correlation analysis,the correlation coefficient was 0.808(P<0.05),which meant that AD and ND had a strong correlation.In the Bland-Altman analysis,only 2 points(5.13%)were outside the 95%CI,indicating higher consistency(94.87%,P<0.05).Conclusion The predicted epidural depth with the handheld ultrasound device has good correlation and consistency with the actual puncture depth,which can be used to guide epidural anesthesia.