超声引导下胸椎旁阻滞致肋间血管损伤的发生率及危险因素

Prevalence of intercostal vascular injury associated with ultrasound-guided thoracic paravertebral block and risk factors

目的寻找与超声引导下椎旁阻滞导致肋间血管损伤的危险因素,进而发现更安全的超声引导下椎旁阻滞实施方法。方法回顾性收集了2020年1月-2022年4月因胸科手术需要术后镇痛接受超声引导下椎旁阻滞患者的术前人口学、麻醉学相关资料,计算超声引导下椎旁阻滞导致肋间血管损伤的发生率,采用单变量和多变量Logistic回归分析探讨与超声引导下椎旁阻滞引起肋间血管损伤的独立危险因素。结果研究纳入1366例患者,253例(18.5%)患者发生肋间血管损伤,确定了超声引导下椎旁阻滞肋间血管损伤相关的4个危险因素:年龄≥65岁(OR=31.407,95%CI:[19.116,51.600],P<0.001),体重指数≥25 kg/m^(2)(OR=4.754,95%CI:[3.352,6.740],P<0.001),阻滞穿刺点位置偏移肋间隙中部略下方(OR=1.947,95%CI:[1.333,2.845],P<0.001),单节段阻滞的操作时间<5 min(OR=12.063,95%CI:[6.840,21.276],P<0.001)。结论超声引导下椎旁阻滞前应保证充分的扫描时间,仔细扫描椎旁三角区的肋间血管以及可能存在的肋间动脉解剖变异。尤其对于65岁以上老年患者以及体重指数≥25的患者,穿刺时尽量避开肋间动脉,建议在肋间中部稍低的位置穿刺。

Objective Ultrasound-guided paravertebral block may cause intercostal vascular injury,which would have serious clinical consequences.The purpose of this study is to find out the risk factors of intercostal vascular injury related to ultrasound-guided paravertebral block,and then find a safer method of ultrasoundguided paravertebral block.Methods The preoperative demographic and anesthesiological data of patients undergoing ultrasound-guided paravertebral block due to postoperative analgesia during thoracic surgery from January 2020 to April 2022 were retrospectively collected,the incidence of intercostal vascular injury caused by ultrasound-guided paravertebral block calculated,and univariate and multivariate logistic regression analysis used to explore the independent risk factors related to the intercostal vascular injury related to ultrasoundguided paravertebral block.Results Of the 1366 patients included in the study,253(18.5%)had intercostal vascular injury associated with paravertebral block under ultrasound guidance.Four risk factors related to the injury of intercostal blood vessels during ultrasound-guided paravertebral block were determined:age≥65 years(OR=31.407,95%CI:[19.116,51.600],P<0.001),body mass index≥25 kg/m^(2)(OR=4.754,95%CI:[3.352,6.740],P<0.001),and the block puncture point slightly being lower than the middle of the intercostal space(OR=1.947,95%CI:[1.333,2.845],P<0.001),and the operation time of single-segment block being less than 5 min(OR=12.063,95%CI:[6.840,21.276],P<0.001).Conclusion Before paravertebral block guided by ultrasound,sufficient scanning time should be guaranteed,and the intercostal vessels and possible anatomical variations of intercostal arteries in the paravertebral triangle should be carefully scanned.Especially for elderly patients over 65 years old and patients with a body mass index≥25,the intercostal artery should be avoided during puncture,and it is recommended to puncture at a slightly lower position in the middle of the intercostal artery.