【超声横切扫描定位在肥胖患者硬膜外穿刺中的应用】 超声纵切与横切

　　[摘要] 目的 评估超声横切扫描定位在肥胖患者硬膜外穿刺应用的可行性及应用前景。 方法 选择76例拟行硬膜外穿刺的肥胖患者。随机分为传统定位组（c组）和超声横切扫描定位组（u组），每组各38例。c组采用常规方法进行定位穿刺，u组采用超声成像（横切扫描，高清晰12L5高频电子线阵探头）定位脊柱正中线、所要穿刺椎间隙并测量皮肤至硬膜外间隙的距离（超声深度，UD）。穿刺成功后，利用标记有刻度的硬膜外穿刺针测量经皮肤到达硬膜外间隙的深度（进针深度，ND）。观察两组穿刺时间、成功率，术后腰痛发生率等指标以及u组UD和ND并进行比较。 结果 76例肥胖患者中，u组穿刺时间比c组明显缩短（P ＜ 0.05），38例肥胖患者均穿刺成功，成功率为100.0%；术后腰痛并发症发生率也低于c组。c组有3例下肢手术患者穿刺失败改全身麻醉。超声深度为（5.76±0.78）cm（4.4～8.7 cm），而进针深度为（5.77±0.76）cm（4.5～8.8 cm），两者行直线回归分析（r = 0.571），相关性较好。 结论 经超声横切扫描定位的肥胖患者硬膜外穿刺成功率高，穿刺时间短，并发症少，安全性高，这提示超声横切扫描法可以为肥胖患者硬膜外穿刺提供可靠的定位标志。
　　[关键词] 超声；横切扫描；定位；肥胖；硬膜外穿刺
　　[中图分类号] R614 [文献标识码] A [文章编号] 1673-7210（2012）08（b）-0075-02
　　The application of ultrasound positioning using the transverse approach in the epidural puncture of obese patients
　　WANG Fuchao1 ZHANG Tongjun1▲ SUN Xuefei1 JIN Hongxu1 WANG Zhibin2 WANG Zhongyi1
　　1.Department of Anesthesiology, Harrison International Peace Hospital of Hengshui City, Hebei Province, Hengshui 053000, China; 2.Department of Anesthesiology, the Fifth People′s Hospital of Hengshui City, Hebei Province, Hengshui 053000, China
　　[Abstract] Objective To evaluate the feasibility and prospects of ultrasound positioning using the transverse approach in obese patients with epidural puncture. Methods 76 cases of obese patients scheduled for epidural puncture were selected. The patients were randomly divided into the traditional positioning (group c) and ultrasound positioning using the transverse approach group (group u), each group had 38 cases. Group c used conventional methods to locate and puncture and group u used ultrasonic image (cross-section of scanning, high-definition 12L5 high-frequency electronic linear array probe) to locate spinal midline, intervertebral space which to be punctured and measured the distance between skin to the epidural space (Ultrasonic depth, UD). After successful puncturing, measured the depth between skin to the epidural space with the scale of the epidural needle (Depth of needle, ND). To observe and compare puncture time, success rate, incidence of low back pain and other indicators as well as UD and ND of group u. Results In 76 cases of obese patients, the puncture time in group u was significantly shorter than group c (P ＜ 0.05). 38 cases of obese patients were all punctured successfully and the success rate was 100.0%. Incidence of low back pain was also lower than group c. Because 3 cases of patients with lower extremity surgery in group c puncture failed, we chose the general anesthesia. The ultrasonic depth was (5.76±0.78)cm (4.4-8.7 cm) and the depth of needle was (5.77±0.76) cm (4.5-8.8 cm). They were related to consistency (r = 0.571). Conclusion Epidural puncture′s success rate was higher, puncture time was shorter, complications were fewer and safety was higher by ultrasound positioning using the transverse approach in obese patients. It is suggested that ultrasound positioning using the transverse approach method could provide reliable sign for obese patients" epidural puncture.