肥胖患者两种低位硬膜外穿刺法的比较  

Comparison of two different low-set epidural puncture on obese patients

作　　者：罗金涛[1] 秦海庆[1] 

机构地区：[1]上海市杨浦区中心医院麻醉科,200090

出　　处：《中国实用医药》2007年第6期2-4,共3页China Practical Medicine

摘　　要：目的比较肥胖患者两种低位硬膜外穿刺法的成功率、置管顺利度及术后腰痛的发生率。方法对120例盆腔及下肢手术的肥胖患者随机分为A、B两组,A组为旁入法,B组为直入法,作为对照组。每组各60例。A组结合人体脊柱解剖特点,采用棘突中点旁开1．5cm处为穿刺点,沿对应棘突进行穿刺;B组采用直入法以棘突间隙中点为穿刺点,垂直进针。观察两组病人穿刺的成功率、置管顺利度及术后腰痛的发生率。结果A组穿刺成功率98．33%,B组为66．67%,差异具有显著性(P＜0．05)。差异具有统计学意义(P＜0．05)。A组置管顺利度96．7%,B组为56．7%。具有显著差异性(P＜0．01)。A组术后腰痛的发生率3%,B组为20%,差异亦有显著性(P＜0．01)。结论肥胖患者低位硬膜外棘突中点旁入法优于直入法,值得推广应用。Objective To compare two kinds of low-set epidural puncture on obese patients in achievement ratio of puncturing,successful rate of epidural catheter placement and incidence rate of postopera- tive lumbar pain.Methods 120 cases of obese patients who neened operations on pelvic cavity or lower ex- tremity were divided into two groups(groups A and B)randomly and averagely.Group A:In combination with anatomic characteristics of human body's spine,the point 1.5cm to midpoint of spinons process was taken as the puncture point,and the needle was inserted along corresponding spinous process;Group B:the midpoint of interspinous process was taken as the puncture point,and the needle was inserted vertically.Results The achievement ratio in group A was 98.33%,while that in group B was 66.67%,the differences between the two groups had statistical significance(P＜0.05).The successful rates of epidural catheter placement of group A and B were 96.7% and 56.7% respectively,there was significant difference between the two groups(P＜0.01).Besides,the incidence rates of postoperative lumbar pain of group A and B were 3% and 20% respec- tively,and there was also significant difference between the two groups(P＜0.01).Conclusion Compared with the puncture from interspinous process,the puncture from perispinons process has more advantages,it de- serves to be widely applied.

关 键 词：麻醉 硬膜外 穿刺术 棘突旁 直入法 

分 类 号：R614[医药卫生—麻醉学]