超声辅助定位与体表标记定位旁正中入路腰麻在老年人髋部骨折手术中的应用

Comparison between ultrasound-assisted and landmark-guided paramedian spinal anesthesia for hip fracture surgery in the elderly

目的探索与体表标记定位技术相比,超声辅助定位技术对老年髋部骨折患者旁正中入路腰麻的效率。方法拟行择期髋部骨折手术的老年患者(年龄≥65岁)以1∶1的比例随机进入超声辅助定位或体表标记定位旁正中入路腰麻组,主要观察指标为腰麻穿刺成功所需的进针次数,次要观察指标包括首次进针穿刺成功率、穿刺点数量、首个穿刺点穿刺成功率、腰麻操作总时间和不良反应。结果共88例受试者进入随机分组。超声辅助定位旁正中入路腰麻组穿刺成功所需的进针次数显著少于体表标记定位旁正中入路腰麻组[2.0(1.0,3.0)次比5.0(3.0,8.8)次,Z=-4.708、P<0.001],超声辅助定位旁正中入路腰麻组首次进针穿刺成功率高于体表标记定位旁正中入路腰麻组[40.9%(18/44)比4.5%(2/44),χ^(2)=16.565、P<0.001],穿刺点数量和首个穿刺点穿刺成功率两组间差异均无统计学意义(均P>0.05)。超声辅助定位旁正中入路腰麻组腰麻操作总时间长于体表标记定位旁正中入路腰麻组[252(218,317)s比168(143,195)s,Z=-5.592、P<0.001],超声辅助定位旁正中入路腰麻组脑脊液回流带血的发生率低于体表标记定位旁正中入路腰麻组[0%(0/44)比18.2%(8/44),χ^(2)=6.738、P=0.009]。结论在老年髋部骨折手术患者中,超声辅助定位旁正中入路腰麻穿刺成功所需的进针次数显著少于体表标记定位旁正中入路腰麻,提示超声辅助定位技术可以被推荐用于老年髋部骨折手术患者。

Objective To investigate the efficiency of the ultrasonic-assisted positioning technique for lumbar anesthesia in elderly patients with hip fractures through the paramedian approach compared with body surface labeling.Methods Patients(aged≥65 years)with hip fractures were randomized(1∶1)to receive either ultrasound-assisted or landmark-guided paramedian spinal anesthesia in a lateral position.The primary outcome was the number of needle passes needed for a successful dural puncture.The secondary outcomes included one-pass success rate,number of needle attempts,one-attempt success rate,total time of spinal anesthesia and adverse effects.Results A total of 88 subjects were randomized.The ultrasound-assisted approach significantly reduced the number of needle passes,compared with the landmark-guided approach[2.0(1.0-3.0)vs.5.0(3.0-8.8);Z=-4.708,P<0.001].The one-pass success rate was higher in the ultrasound-assisted approach than in the landmark-guided approach[40.9%(18/44)vs.4.5%(2/44);χ^(2)=16.565,P<0.001].There was no statistical difference in the number of needle attempts and one-attempt success rate between the two groups(P>0.05 for both).The total time of spinal anesthesia was longer in the ultrasound-assisted group than in the landmark-guided group[252(218-317)s vs.168(143-195)s;Z=-5.592,P<0.001].In the ultrasound-assisted group,fewer patients developed bloody cerebral spinal fluid taps than in the landmark-guided group[0%(0/44)vs.18.2%(8/44);χ^(2)=6.738,P=0.009].Conclusions In elderly hip fracture patients,ultrasound-assisted paramedian spinal anesthesia is superior to the landmark-guided approach in reducing the number of needle passes and should be recommended for these patients.