超声仪在分娩镇痛中估测硬膜外深度及穿刺定位的准确性研究

Accuracy of Ultrasonography in Estimating Epidural Depth and Puncture Positioning During Labor Analgesia

目的分析超声仪在分娩镇痛中估测硬膜外深度及穿刺定位的准确性。方法对本院2021年8月-2022年2月收治的100例开展硬膜外分娩镇痛干预的产妇临床资料进行回顾性分析,根据其穿刺定位方法的不同将其分为甲组和乙组,其中甲组共计50例产妇均以传统手法触摸解剖标记并实施定位,乙组共计50例产妇均以超声仪实施穿刺定位,对两组产妇的首次穿刺成功率以及更换间隙穿刺率进行比较,同时观察组间穿刺次数差异、组间重新定向次数差异、组间操作耗时差异以及组间硬膜外穿刺相关并发症发生率差异,记录乙组硬膜外深度以及硬膜外穿刺针实际进针深度。结果组间首次穿刺成功率比较,乙组明显高于甲组(P<0.05),组间更换间隙穿刺率比较,乙组低于甲组,差异无统计学意义(P>0.05)。组间穿刺次数比较,乙组明显低于甲组,组间重新定向次数比较,乙组明显低于甲组,组间操作耗时比较,乙组明显短于甲组(P<0.05)。组间硬脊膜穿破发生率比较、组间神经根损伤发生率比较、组间硬膜外血肿发生率比较,乙组低于甲组,差异均无统计学意义(P>0.05)。乙组产妇硬膜外深度估测值为(4.28±0.40)cm,硬膜外穿刺针实际进针深度为(4.49±0.39)cm,两者的绝对值和差数均值分别为0.49cm和0.20cm。结论在产妇分娩镇痛中,超声仪在硬膜外深度估测方面以及穿刺定位方面具有良好的应用价值,不仅可以提高首次穿刺成功率,而且还可以进一步减少穿刺次数,缩短操作耗时,硬膜外穿刺相关并发症发生率低,且硬膜外深度估测值和膜外穿刺针实际进针深度相差较小,准确性高,值得推广。

Objective To analyze the accuracy of ultrasonography in estimating epidural depth and puncture positioning in labor analgesia.Methods The clinical data of 100 puerperae who underwent epidural labor analgesia intervention in our hospital from August 2021 to February 2022 were retrospectively analyzed,and they were divided into group A and group B according to their different puncture positioning methods.Among them,a total of 50 puerperae in group A all used traditional manipulation to touch anatomical markers and perform positioning,and a total of 50 puerperae in group B all performed puncture positioning with an ultrasound instrument.The differences in the number of punctures,the number of redirections between the groups,the time-consuming operation between the groups,and the incidence of complications related to epidural puncture between the groups were observed,and the epidural depth and the actual needle insertion of the epidural needle in group B were recorded.Results The success rate of the first puncture between the groups was significantly higher in group B than in group A(P<0.05),and the puncture rate of replacement gap between groups was lower than that in group A,with no significant difference(P>0.05).Compared with group A,the number of punctures in group B was significantly lower and the number of reorientations in group B was significantly lower,the operation time in group B was significantly shorter(P<0.05).The incidence of dural perforation between groups,the incidence of nerve root injury between groups,and the incidence of epidural hematoma between groups were lower than those of group A,and the differences were not statistically significant(all P>0.05).The estimated epidural depth of the puerperae in group B was(4.28±0.40)cm,and the actual depth of epidural puncture needle was(4.49±0.39)cm.The absolute value and the mean difference between the two were 0.49 cm and 0.20cm,respectively.Conclusion In maternal labor analgesia,ultrasonography has good application value in epidural depth estimation and puncture positioning,which can not only improve the success rate of the first puncture,but also further reduce the number of punctures and operation time.The incidence of complications related to epidural puncture is low,and the difference between the estimated epidural depth and the actual needle depth of the epidural puncture needle is small,and the accuracy is high,which is worthy of promotion.