手持式便携超声仪在肥胖产妇硬膜外麻醉中的应用效果  

Application Effect of Handheld Portable Ultrasound Instrument in Epidural Anesthesia of Obese Parturients and Its Impact on Stress Response Factors

作　　者：张俊丽 胡金荣 隋明鑫 马加海[2] ZHANG Junli;HU Jinrong;SUI Mingxin;MA Jiahai(The Second Clinical Medical College of Binzhou Medical College,Yantai,Shandong 264100,China;Yantai Yuhuangding Hospital,Yantai,Shandong 264000,China)

机构地区：[1]滨州医学院第二临床医学院,山东烟台264100 [2]烟台毓璜顶医院麻醉科,山东烟台264000

出　　处：《临床误诊误治》2023年第5期113-118,共6页Clinical Misdiagnosis & Mistherapy

基　　金：山东省卫健委医疗管理中心项目(SDWJYLGLYJZX-2021-001)。

摘　　要：目的探究手持式便携超声仪对肥胖产妇硬膜外麻醉的效果及应激反应因子的影响。方法选择2021年7—10月择期行硬膜外麻醉剖宫产术的肥胖产妇60例。依据随机数字表法分为手持式便携超声仪组(超声组)和触诊组,每组30例。观察手持式便携超声仪测量皮肤至硬膜外腔距离与实际进针深度的相关性;比较2组穿刺情况及患者满意度、麻醉相关评分及产时发热率、应激反应因子水平;记录不同时间点新生儿Apgar评分、麻醉相关并发症及腰椎软组织损伤发生情况。结果触诊组因更换麻醉方式失访1例,最终纳入59例产妇。超声测量皮肤至硬膜外腔距离与实际进针深度具有相关性(r=0.926,P<0.001)。超声组首针穿刺成功率高于触诊组,插针次数及穿刺次数少于触诊组,定位时间长于触诊组,穿刺时间短于触诊组,患者满意度高于触诊组(P<0.05,P<0.01)。超声组硬膜外麻醉效果评分高于触诊组,视觉模拟评分法评分低于触诊组(P<0.05,P<0.01)。分娩后6 h,2组促肾上腺皮质激素、皮质醇、去甲肾上腺素、C反应蛋白均高于麻醉前,但超声组低于触诊组(P<0.05)。2组不同时间点新生儿Apgar评分比较差异无统计学意义(P>0.05)。2组均未发生严重并发症。结论手持式便携超声仪可有效减少肥胖产妇硬膜外麻醉失误、提高硬膜外穿刺准确性和产妇满意度,减少对腰椎软组织的损伤,降低麻醉相关应激反应因子水平。Objective To explore the effect of hand-held portable ultrasound scanner in epidural anesthesia in obese parturients and its impact on the stress response factors.Methods Sixty obese parturients who underwent elective caesarean section under epidural anesthesia from July to October 2021 were selected.According to random number table method,the patients were divided into hand-held portable ultrasound scanner group(ultrasound group)and palpation group,with 30 cases in each group.The correlation of the depth from skin to epidural space with the actual insertion depth of epidural puncture measured hand-held portable ultrasound scanner was observed.Puncture situation,patient satisfaction,anaesthesia-related score,intrapartum fever rate,and levels of stress response factor indexes were compared.Apgar score at different time points,anesthesia-related complications and lumbar soft tissue injury of newborns were recorded.Results In the palpation group,one case was lost to follow-up due to the change of anesthesia method,and 59 cases of parturients were finally included.The depth from skin to epidural space measured by ultrasound was correlated with the actual insertion depth of epidural puncture(r=0.926,P<0.001).The success rate of first needle puncture in ultrasound group was higher,the number of needle insertion and puncture times were lower,the positioning time was longer,the puncture time was shorter,and the patient satisfaction was higher,as compared with those in palpation group(P<0.05,P<0.01).Effect of epidural anesthesia in ultrasound group was higher,and visual analog score was lower,as compared with those in palpation group(P<0.05,P<0.01).At 6 h after delivery,adrenocorticotropic hormone,cortisol,norepinephrine,and C reactive protein in the two groups were higher than those before anesthesia,but lower in ultrasound group than in palpation group(P<0.05).There was no significant difference in Apgar score between the two groups(P>0.05).No serious complications occurred in the two groups.Conclusion Hand-held portabl

关 键 词：剖宫产术 麻醉 硬膜外 手持式便携超声仪 促肾上腺皮质激素 皮质醇 去甲肾上腺素 C反应蛋白 APGAR评分 

分 类 号：R713.144.2[医药卫生—妇产科学]