改良针内针穿刺技术在老年患者单侧全髋关节置换术中的应用  

Application of modified needle-through-needle puncture technique in unilateral total hip arthroplasty in elderly patients

作　　者：官永银 林华阳 饶福东[2] 林洁[2] 修忠标[3] 刘洪[3] 张良志 杨婷婷 屈云宵 方寒冰 孙鹤 GUAN Yongyin;LIN Huayang;RAO Fudong;LIN Jie;XIU Zhongbiao;LIU Hong;ZHANG Liangzhi;YANG Tingting;QU Yunxiao;FANG Hanbing;SUN He(Department of Anesthesiology,Third Affiliated People’s Hospital,Fujian University of Traditional Chinese Medicine,Fuzhou 350108,China;Department of Anesthesiology,Affiliated People’s Hospital,Fujian University of Traditional Chinese Medicine,Fuzhou 350004,China;Department of Orthopedic,Affiliated People’s Hospital,Fujian University of Traditional Chinese Medicine,Fuzhou 350004,China)

机构地区：[1]福建中医药大学附属第三人民医院麻醉科,福建福州350108 [2]福建中医药大学附属人民医院麻醉科,福建福州350004 [3]福建中医药大学附属人民医院骨伤科,福建福州350004 [4]福建中医药大学

出　　处：《吉林大学学报（医学版）》2023年第5期1325-1331,共7页Journal of Jilin University：Medicine Edition

基　　金：国家自然科学基金面上项目(81873315);福建省科技厅社会发展引导性(重点)基金项目(2019Y0034)。

摘　　要：目的:探讨改良针内针穿刺技术在老年患者单侧全髋关节置换术中的应用,阐明其在超声定位引导下单次等比重脊椎麻醉中的麻醉效果和可行性。方法:选择行单侧全髋关节置换术且实施单次等比重脊椎麻醉的60例老年患者为研究对象,患者均采用患侧在上的侧卧手术体位进行穿刺。60例患者随机分为传统组和改良组,每组各30例。所有患者经超声定位棘突间隙后,行正中入路的单次蛛网膜下腔穿刺,以穿刺针见脑脊液流出或抽出判定为穿刺成功。传统组患者采用传统的针内针技术(破皮后16 G硬膜外穿刺针穿刺引导、套用25 G笔尖式侧孔脊麻穿刺针);改良组患者采用改良的针内针技术(20 G注射针直接破皮引导、套用25 G笔尖式侧孔脊麻穿刺针)。观察2组患者1次穿刺成功率、2次穿刺成功率、1次皮肤穿刺成功率、2次皮肤穿刺成功率、穿刺时间、患者满意率、麻醉起效时间、满足所需麻醉平面率、麻醉平面固定时间、术者对肌松满意度、手术时间、PACU停留时间和麻醉操作即刻不良反应及术后48 h内不良反应。结果:所有患者穿刺成功。与传统组比较,改良组患者1次穿刺成功率、2次穿刺成功率、1次皮肤穿刺成功率和2次皮肤穿刺成功率高(P<0.01),穿刺时间短(P<0.01),患者满意率高(P<0.01),麻醉起效时间缩短(P<0.01),麻醉平面固定时间延迟(P<0.01),术者对肌松满意率高(P<0.01),麻醉10 min和术后10 min患者平均动脉压(MAP)及心率(HR)升高(P<0.05)。与传统组比较,改良组患者麻醉穿刺操作过程即刻不良反应和术后48 h内不良反应发生率差异无统计学意义(P>0.05)。结论:行单侧全髋关节置换术的老年患者,穿刺前先超声定位,采用改良针内针穿刺技术行非可视条件下单次等比重脊椎麻醉,可明显减少穿刺次数和穿刺时间,提高穿刺成功率。Objective:To discuss the application of the modified needle-through-needle puncture technique in unilateral total hip arthroplasty in the elderly patients,and to clarify its anesthetic effect and feasibility in the single isospecific gravity spinal anesthesia guided by ultrasound.Methods:Sixty elderly patients underwent elective unilateral hip arthroplasty with single isobaric gravity spinal anesthesia were selected.The puncture was performed in the patients with the affected side upper in the lateral position.Sixty patients were divided into tradition group and modification group,and there were 30 patients in each group.After the ultrasonic localization of spinous process space,the single subarachnoid puncture through median approach was performed in all the patients,and the successful puncture was determined by the outflow or drawn-out of cerebrospinal fluid in the spinal anesthesia needle.The patients in tradition group were treated with the traditional needle-through-needle puncture technique(a 16 G epidural puncture needle was used to guide the puncture,and a 25 G pencil-point side-hole spinal needle was applied);the patients in modification group were treated with the modified needle-through-needle puncture technique(a 20 G injection needle was used to break the skin directly for guidance,and a 25 G pencil-point side-hole spinal needle was applied).The once-puncture success rates,twice-puncture success rates,first-skin-attempt puncture success rates,and twice-skin-attempt puncture success rates,puncture time,patients’satisfaction rates,onset-time of anesthesia,assessment of anesthesia block,fixation-time of anesthesia,satisfaction of surgeon for muscle relaxation,operation time,residence time in PACU,immediate adverse reactions during anesthesia,and adverse reactions within 48 h after operation of the patients in two groups were compared.Results:All the patients had successful punctures.Compared with tradition group,the once-puncture success rate,twicepuncture success rate,first-skin-attempt puncture succ

关 键 词：脊椎麻醉 改良针内针穿刺技术 超声检查 关节置换术 全髋关节 

分 类 号：R614.3[医药卫生—麻醉学]