Broadbent C R, Maxwell W B, Ferrie R, Wilson D J, Gawne-Cain M, Russell R
Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford OX3 9DU, UK.
Anaesthesia. 2000 Nov;55(11):1122-6. doi: 10.1046/j.1365-2044.2000.01547-4.x.
Anaesthetists' ability to identify correctly a marked lumbar interspace was assessed in 100 patients undergoing spinal magnetic resonance imaging scans. Using ink, one anaesthetist marked an interspace on the lower spine and attempted to identify its level with the patient in the sitting position. A second anaesthetist attempted to identify the level with the patient in the flexed lateral position. A marker capsule was taped over the ink mark and a routine scan performed. The actual level of markers ranged from one space below to four spaces above the level at which the anaesthetist believed it to be. The marker was one space higher than assumed in 51% of cases and was identified correctly in only 29%. Accuracy was unaffected by patient position (sitting or lateral), although it was impaired by obesity (p = 0.001) and positioning of the markers high on the lower back (p < 0.001). The spinal cord terminated below L(1) in 19% of patients. This, together with the risk of accidentally selecting a higher interspace than intended for intrathecal injection, implies that spinal cord trauma is more likely when higher interspaces are selected.
对100例接受脊柱磁共振成像扫描的患者评估麻醉医生正确识别标记腰椎间隙的能力。一名麻醉医生用墨水在患者下脊柱标记一个间隙，并试图在患者坐位时确定其节段水平。另一名麻醉医生试图在患者侧卧位屈曲时确定其节段水平。在墨水标记处粘贴一个标记胶囊，然后进行常规扫描。标记的实际节段水平比麻醉医生认为的节段水平低一个间隙到高四个间隙。在51%的病例中，标记比预期高一个间隙，只有29%被正确识别。准确性不受患者体位（坐位或侧卧位）影响，尽管肥胖（p = 0.001）和标记位于下背部较高位置（p < 0.001）会损害准确性。19%的患者脊髓终止于L(1)以下。这一点，再加上意外选择比预期更高的间隙进行鞘内注射的风险，意味着选择较高间隙时脊髓损伤更有可能发生。
