体表标记与超声定位椎管内麻醉在输尿管硬镜手术中的临床研究

Clinical study on body surface marker localization and ultrasound-guided positioning for intraspinal anesthesia in ureteroscopic surgery

目的比较超声定位与体表标记定位下行椎管内麻醉在输尿管硬镜手术中的应用效果。方法选取玉林市红十字会医院2023-03/2024-05期间行输尿管硬镜手术患者100例,年龄18~79岁,BMI 18.5~30.0 kg/m^(2),ASA分级Ⅰ或Ⅱ级,采用随机数字表法将患者分为对照组(n=50)和超声组(n=50)。使用超声扫描法及体表标记法对所有患者的椎间隙进行定位后,对照组利用体表标记定位进行椎管内穿刺术,超声组利用超声定位进行椎管内穿刺术。记录两种定位方法下的椎间隙的一致率,记录两组患者首次穿刺成功率、穿刺时间、穿刺次数、相关并发症发生率、麻醉效果数据。结果使用体表标记定位与超声定位的椎间隙的一致率为40%,超声组首次穿刺成功率(36%)高于对照组(26%),差异有统计学意义(P<0.05)。超声组穿次时间、穿刺次数、调针次数依次为(4.70±0.88)分、(1.32±0.55)次、(1.08±1.00)次,对照组穿刺时间、穿刺次数、调针次数依次为(5.43±1.49)分、(1.82±1.00)次、(1.94±1.78)次,两组比较差异有统计学意义(P<0.05)。两组患者麻醉成功率及满意度为100%,均未使用血管活性药物,差异无统计学意义(P>0.05),超声组术后腰痛发生率(8.0%)较对照组(24.0%)低,超声组穿刺或置管时异感发生率(2.0%)较对照组(16.0%)低,差异有统计学意义(P<0.05)。结论超声定位下行椎管内麻醉能提高椎管内首次穿刺成功率,提高椎管内穿刺质量。

Objective To compare the application effect of ultrasound-guided positioning and body surface marker localization for intraspinal anesthesia in ureteroscopic surgery.Methods A total of 100 patients,aged 18-79 years,with BMI 18.5-30.0 kg/m^(2),ASAⅠorⅡ,who underwent ureteroscopic surgery in the Red Cross Hospital of Yulin City from March 2023 to May 2024 were divided into the control group(n=50)and the ultrasound group(n=50)according to random number table method.The control group performed intraspinal puncture operation using body surface marker localization method,and the ultrasound group performed intraspinal puncture operation using ultrasound-guided positioning method.The consistency rate of the two positioning methods was recorded,and the data of the first puncture success rate,puncture time,puncture times,the incidence of related complications and anesthesia effect of patients in the two groups were recorded.Results The coincidence rate of locating intervertebral space by ultrasound-guided positioning and body surface marker localization was 40%,the first success rate of the intraspinal puncture in the ultrasound group(36%)was higher than that in the control group(26%),with statistical significance(P<0.05).The puncture time,the puncture times,and the needle adjustment times of the ultrasound group were(4.70±0.88)min,(1.32±0.55)times,and(1.82±1.00)times respectively,and the puncture time,the puncture times,and the needle adjustment times of the control group were(5.43±1.49)min,(1.82±1.00)times,(1.94±1.78)times respectively.There was significant difference between the two groups(P<0.05).The success rate and satisfaction rate of anesthesia effect of both groups were 100%,and vasoactive drugs were not used during anesthesia,with none statistical significance(P>0.05).The incidence of postoperative lumbago in the ultrasound group(8.0%)was lower than that in the control group(24.0%),and the incidence of abnormal sensation in the ultrasound group(2.0%)was lower than that in the control group(16.0%),with statistical significance(P<0.05).Conclusion Ultrasound-guided intraspinal puncture operation can improve the first success rate of the intraspinal puncture and the quality of intraspinal puncture.