肥胖孕产妇剖宫产术椎管内麻醉时不同定位及穿刺方式效果的比较  

Comparison of effects of different positioning and puncture methods for epidural anesthesia in obese parturients undergoing cesarean section

作　　者：郭高锋[1] 豆立冬[1] 崔明珠[1] 张加强[1] 容雄飞[1] Guo Gaofeng;Dou Lidong;Cui Mingzhu;Zhang Jiaqiang;Rong Xiongfei(Department of Anesthesia and Perioperative Medicine,Henan Provincial People′s Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院麻醉与围术期医学科,郑州450003

出　　处：《中华麻醉学杂志》2024年第12期1470-1475,共6页Chinese Journal of Anesthesiology

基　　金：河南省医学教育研究项目(WJLX2024007);河南省医学科技攻关计划项目(LHGJ20220068)。

摘　　要：目的比较肥胖孕产妇剖宫产术椎管内麻醉时不同定位及穿刺方式的效果。方法选取2023年7月至2024年4月在河南省人民医院择期椎管内麻醉下行剖宫产术的足月肥胖孕产妇175例,ASA分级Ⅰ或Ⅱ级,BMI>30 kg/m^(2),采用随机数字表法分为4组:触诊法定位+正中入路穿刺组(PM组,n=44)、体表标志法定位+旁正中入路穿刺组(BP组,n=43)、超声辅助定位+旁正中入路穿刺组(UP组,n=45)和超声辅助定位+超声引导平面内穿刺组(UU组,n=43)。分别由熟练掌握4种不同椎管内麻醉定位及穿刺方法的麻醉科住院医师进行操作。主要观察指标:一次穿刺成功率和总穿刺成功率;次要观察指标:穿刺次数、穿刺间隙改变情况、定位时间、穿刺时间、麻醉操作时间,穿刺后恶心呕吐、穿刺感觉异常、穿刺部位出血的发生情况和孕产妇满意率,以及术后7 d、1个月、2个月和3个月时腰痛发生情况。结果PM组有2例、BP组有2例、UP组有2例、UU组有2例剔除本研究。总穿刺成功率:PM组为95%(40/42),BP组为98%(40/41),UP为93%(40/43),UU组为98%(40/41);4组总穿刺成功率比较差异无统计学意义(P>0.05)。与PM组比较,BP组一次穿刺成功率升高,穿刺间隙改变率降低,定位时间缩短,恶心呕吐发生率降低,满意率升高,术后7 d时腰痛发生率降低;UP组一次穿刺成功率升高,穿刺次数减少,穿刺间隙改变率降低,定位时间、穿刺时间和麻醉操作时间均缩短,满意率升高,术后7 d时腰痛发生率降低;UU组改变穿刺间隙率降低,定位时间缩短(P<0.05)。与BP组比较,UP组穿刺时间缩短,UU组穿刺次数增多,麻醉操作时间延长,恶心呕吐发生率升高,满意率降低(P<0.05)。与UP组比较,UU组一次穿刺成功率降低,穿刺次数增多,穿刺时间和麻醉操作时间延长,恶心呕吐发生率升高,满意率降低(P<0.05)。结论超声辅助定位联合旁正中入路穿刺可提高剖宫产术肥胖孕产妇椎管内麻醉�Objective To compare the effects of different positioning and puncture methods for epidural anesthesia in obese parturients undergoing cesarean section.MethodsIn this prospective,randomized,controlled study,175 obese parturients,of American Society of Anesthesiologists Physical Status classificationⅠorⅡ,with a body mass index of>30 kg/m^(2),who underwent elective cesarean section with epidural anesthesia at Henan Provincial People′s Hospital from July 2023 to April 2024,were selected and assigned into 4 groups using a random number table method:palpation positioning+median approach to puncture group(PM group,n=44),body surface marker positioning+paramedian approach to puncture group(BP group,n=43),ultrasound-assisted positioning+paramedian approach to puncture group(UP group,n=45),and ultrasound-assisted positioning+ultrasound-guided in-plane approach to puncture group(UU group,n=43).The procedures were performed by anesthesiology residents skilled in the four different epidural anesthesia positioning and puncture methods.Main observation indicators:success rate of puncture at first attempt and total success rate of puncture.Secondary observation indicators:the number of puncture,changes in puncture interspaces,positioning time,puncture time,anesthesia operation time,postoperative nausea and vomiting,sensory abnormalities at the puncture site,bleeding at the puncture site,maternal satisfaction rates,and occurrence of low back pain at day 7,1 month,2 months,and 3 months postoperatively.ResultsIn this study,2 cases were excluded from PM group,2 from BP group,2 from UP group,and 2 from UU group.The total success rates of puncture were as follows:95%(40/42)in PM group,98%(40/41)in BP group,93%(40/43)in UP group,and 98%(40/41)in UU group.There was no significant difference in the total success rates of puncture among the four groups(P>0.05).Compared to PM group,the success rate of puncture at first attempt was significantly increased,the rate of changes in puncture interspaces was decreased,the positioning time

关 键 词：妊娠期肥胖 剖宫产术 麻醉 脊椎 定位标记 穿刺术 

分 类 号：R47[医药卫生—护理学]