剖宫产术患者三维脊柱超声引导硬膜外穿刺术的效果

Effects of epidural puncture guided by SpineNav3D Ultrasound Device in patients undergoing cesarean section

目的评价剖宫产术患者三维脊柱超声引导硬膜外穿刺术的效果。方法选取硬膜外-脊椎联合麻醉下行剖宫产术的患者110例,采用随机数字表法分为触诊定位组(P组)和超声定位组(U组),每组55例。P组采用解剖标记进行穿刺定位;U组采用三维脊柱超声的脊柱模式进行穿刺定位,并记录超声测量的硬膜外深度。2组均首选L2,3椎间隙进行穿刺,均采用正中入路。记录穿刺成功情况、穿刺次数、穿刺针方向调整次数、硬膜外腔实际进针深度、定位时间、穿刺时间、操作时间、总时间以及硬膜外穿刺相关并发症。结果与P组比较,U组定位时间和总时间延长,1次穿刺成功率升高,穿刺次数和穿刺针方向调整次数减少(P<0.05),总穿刺成功率、穿刺相关并发症发生率差异无统计学意义(P>0.05)。Bland-Altman分析显示,U组硬膜外深度实际值与测量值的差值绝大部分位于95%一致性界限内。结论对于剖宫产术患者,三维脊柱超声可准确测量硬膜外深度,提高硬膜外1次穿刺成功率,且使用方便简单,易于掌握。

Objective To evaluate the effects of epidural puncture guided by SpineNav3D Ultrasound Device in the patients undergoing cesarean section.Methods One hundred and ten parturients undergoing elective cesarean section under combined spinal-epidural anesthesia were divided into palpation group(group P)and ultrasound group(group U)using a random number table method,with 55 cases in each group.In group P,the needle entry location was identified using palpation.While the needle entry point was located using Accuro®SpineNav3D™Mode,and the depth of epidural space was measured and recorded in group U.The L2/3 interspace was the preferred choice for puncture,and the puncture was performed through the median approach.The success of puncture,the number of needle insertion,the number of needle redirection,and actual depth of the epidural space,location time,puncture time,operation time,total time,and complications related to epidural puncture were recorded.Results Compared with group P,the location time and total time were significantly prolonged,the success rate of puncture at first attempt was increased,the number of punctures and the number of needle redirection were decreased(P<0.05),and no significant change was found in the success rate of total punctures and puncture-related complications in group U(P>0.05).The results of Bland-Altman analysis showed that the difference between the actual and measured depth of the epidural space was mostly within the 95%limits of agreement in group U.Conclusion For the patients undergoing cesarean section,the SpineNav3D Ultrasound Device can accurately measure the epidural depth and raise the success rate of first-attempt epidural puncture,and it is convenient to use and master.