不同体位对肥胖产妇椎间隙定位的影响  

Effects of Different Body Positions on the Accuracy of Intervertebral Space Localization in Obese Puerpera

作　　者：徐珂嘉 张俊杰[1] 王艳[1] 苏喆[1] 张光明[1] XU Ke-jia;ZHANG Jun-jie;WANG Yan;SU Zhe;ZHANG Guang-ming(Department of Anesthesiology,Tongren Hospital,Shanghai Jiaotong University School of Medicine,Shanghai,200336,China)

机构地区：[1]上海交通大学医学院附属同仁医院麻醉科,上海200336

出　　处：《现代生物医学进展》2020年第14期2664-2667,共4页Progress in Modern Biomedicine

基　　金：上海市长宁区卫生和计划生育委员会科研项目(20174Y007)。

摘　　要：目的:探讨体位对肥胖产妇椎间隙定位准确性的影响。方法:选择2018年1月-6月在上海市同仁医院建卡并定期产检且预产期在此期间的209例肥胖产妇,根据不同穿刺体位按随机数字表法将其分为坐位组(n=104)和侧卧位组(n=105),采用超声检测作为金标准进行椎间隙定位,比较不同体位下触诊定位椎间隙的精准性,及肥胖程度与定位准确性的关系。结果:与侧卧位组比较,坐位组L3-4椎间隙定位时间显著缩短,皮肤至腰椎棘突距离、红色(手法定位)与黑色标记(超声定位)距离明显缩小(P<0.05)。与侧卧位组比较,坐位组一次穿刺成功率明显升高,穿刺时间明显缩短(P<0.05)。随着BMI的增加,椎间隙定位时间显著延长,皮肤至腰椎棘突距离、红色与黑色标记距离、节段误差率明显增加(P<0.05)。结论:肥胖产妇椎间隙定位准确性与体位及肥胖程度密切相关,坐位下椎间隙触诊定位的准确性优于侧卧位。Objective:To explore the effect of body positions on intervertebral space localization of obese puerpera.Methods:209 cases of obese puerpera who were received regular prenatal and due date within this period from January to June 2018 in Tongren Hospital of Shanghai were chosen.According to the different puncture position,all the patients were divided into sitting position group(n=104)and lateral position group(n=105)by random number table method.Ultrasonic examination was used as the gold standard for intervertebral space localization,and the accuracy of palpation localization of intervertebral space under different body positions was compared,as well as the relationship between obesity degree and localization accuracy.Results:Compared with the lateral position group,the time of L3-4 intervertebral space localization was significantly shortened in the sitting position group,and the distance between skin and lumbar spine,the distance between red marker(palpation positioning)and black marker(ultrasonic localization)were significantly reduced(P<0.05).Compared with the lateral position group,the success rate of first puncture was significantly increased and the puncture time was significantly shortened in the sitting position group(P<0.05).With the increase of BMI,the time of intervertebral space localization was significantly prolonged,the distance between skin and lumbar spine,the distance between red and black marks and segment error rate were significantly increased(P<0.05).Conclusions:The accuracy of intervertebral space localization of obese puerpera is closely related to body position and obesity degree.The accuracy of intervertebral space localization of sitting position is better than that of lateral position.

关 键 词：体位 坐位 侧卧位 肥胖产妇 椎间隙定位 

分 类 号：R714[医药卫生—妇产科学] R614[医药卫生—临床医学]