可视化骶管穿刺技术用于骶尾肥厚患儿的麻醉效果分析  

Analysis of the anesthetic effect of visual sacral canal puncture in children with sacrococcygeal hyperplasia

作　　者：童易如 张号绒 娄曼 魏嵘 Henry Liu Tong Yiru;Zhang Haorong;Lou Man;Wei Rong;Henry Liu(Department of Anesthesiology,Shanghai Children's Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200062,China;Department of Ultrasonography,Shanghai Children's Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200062,China;Department of Anesthesiology and Critical Care,Perelman School of Medicine,University of Pennsylvania,Philadelphia,PA 19102,USA)

机构地区：[1]上海市儿童医院麻醉科上海交通大学医学院,上海200062 [2]上海市儿童医院超声科上海交通大学医学院,上海200062 [3]宾夕法尼亚大学佩雷尔曼医学院麻醉与重症监护科,费城19102

出　　处：《临床小儿外科杂志》2024年第11期1035-1041,共7页Journal of Clinical Pediatric Surgery

基　　金：上海市儿童医院院级课题(2020YLYZ05)。

摘　　要：目的探讨可视化骶管超声定位、臀沟纹穿刺定位技术改善骶尾肥厚患儿骶管穿刺成功率及骶管阻滞的效果。方法回顾性分析2016年7月至2024年1月上海市儿童医院由同一麻醉医师实施的196例接受骶管阻滞的骶尾肥厚患儿临床资料,根据骶管阻滞采用穿刺技术的不同分为传统技术组(125例)、超声定位组(18例)和臀沟纹定位组(53例),收集三组患儿年龄、性别、体重、身高、身体质量指数、首次穿刺成功率、骶管阻滞效果完善率、麻醉开始时及手术划皮时的心率与收缩压。结果与传统技术组相比,超声定位组、臀沟纹定位组均实现了更高的首次穿刺成功率(17/18比78/125,42/53比78/125,P<0.05)和更好的骶管阻滞效果(16/18比78/125,49/53比78/125,P<0.05)。麻醉开始时,传统技术组心率为(92.3±14.1)次/分,超声定位组心率为(104.0±11.6)次/分,臀沟纹定位组心率为(95.4±14.4)次/分;传统技术组收缩压为(99.9±10.6)mmHg,超声定位组收缩压为(99±10.6)mmHg,臀沟纹定位组收缩压为(107.0±11.0)mmHg;上述指标差异均有统计学意义(P<0.05)。手术划皮时,传统技术组心率为(92.4±14.1)次/分,超声定位组心率为(105.0±12.7)次/分,臀沟纹定位组心率为(95.9±15.2)次/分;传统技术组收缩压为(101.0±10.6)mmHg,超声定位组收缩压为(93.9±9.4)mmHg,臀沟纹定位组收缩压为(104.0±10.8)mmHg;上述指标差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,超声定位骶管阻滞技术(OR=7.901,95%CI:1.923~54.913)、臀沟纹定位骶管阻滞技术(OR=11.539,95%CI:3.726~45.950)是提高骶管阻滞有效率的相关因素(P<0.05);患儿身高(OR=1.278,95%CI:1.051~1.574)、体重(OR=0.705,95%CI:0.535~0.908)、身体质量指数(OR=2.273,95%CI:1.182~4.656)、骶管阻滞方法(超声定位骶管阻滞技术:OR=10.046,95%CI:1.908~185.923;臀沟纹定位骶管阻滞技术:OR=3.650,95%CI:1.516~9.890)是提高骶管首次穿刺成功率的相关因素(P<0ObjectiveTo investigate the efficacy of a novel visualization technique for caudal epidural catheterization to improve the success rate and efficacy of caudal block in children with sacrococcygeal hypertrophy.MethodsA retrospective analysis was conducted on 196 cases of children with sacrococcygeal hypertrophy who received caudal block performed by the same anesthesiologist at Shanghai Children's Hospital from July 2016 to January 2024.Based on the different puncture techniques used for the caudal block,the cases were divided into three groups:traditional technique group(125 cases),ultrasound-guided group(18 cases),and intergluteal cleft positioning group(53 cases).Data collected included age,gender,weight,height,body mass index(BMI),first puncture success rate,completion rate of the caudal block effect,heart rate,and systolic blood pressure at the start of anesthesia and during skin incision.ResultsCompared to the traditional technique group,both the ultrasound-guided group and the intergluteal cleft positioning group achieved higher first puncture success rate(17/18 vs.78/125,42/53 vs.78/125,P<0.05)and better caudal block effects(16/18 vs.78/125,49/53 vs.78/125,P<0.05).At the start of anesthesia,the heart rates were(92.3±14.1)beats/min for the traditional technique group,(104.0±11.6)beats/min for the ultrasound-guided group,and(95.4±14.4)beats/min for the gluteal crease positioning group.Systolic blood pressures were(99.9±10.6)mmHg for the traditional technique group,(99±10.6)mmHg for the ultrasound-guided group,and(107.0±11.0)mmHg for the gluteal crease positioning group;all differences in heart rates and systolic blood pressures among the three groups were statistically significant(P<0.05).During skin incision,heart rates were(92.4±14.1)beats/min for the traditional technique group,(105.0±12.7)beats/min for the ultrasound-guided group,and(95.9±15.2)beats/min for the gluteal crease positioning group.Systolic blood pressures were(101.0±10.6)mmHg for the traditional technique group,(93.9±9.4)mmHg for

关 键 词：骶管阻滞 超声 外科手术 儿童 

分 类 号：R47[医药卫生—护理学]