硬膜外穿刺后硬脑膜组织损伤和脑脊液漏：穿刺针设计、角度和斜面方向的影响

Dural tissue trauma and cerebrospinal fluid leak after epidural needle puncture: effect of needle design, angle, and bevel orientation.

作者信息

Angle Pamela J, Kronberg Jean E, Thompson Dorothy E, Ackerley Cameron, Szalai John Paul, Duffin James, Faure Peter

机构信息

Department of Anesthesia, Women's College Hospital Campus, Sunnybrook and Women's College Hospital, University of Toronto, Ontario, Canada.

出版信息

Anesthesiology. 2003 Dec;99(6):1376-82. doi: 10.1097/00000542-200312000-00021.

DOI:10.1097/00000542-200312000-00021

PMID:14639152

Abstract

BACKGROUND

The effects of epidural needle design, angle, and bevel orientation on cerebrospinal fluid leak after puncture have not been reported. The impact of these factors on leak rate was examined using a dural sac model. Dural trauma was examined using scanning electron microscopy.

METHODS

Human cadaveric dura, mounted on a cylindrical model, was punctured with epidural needles using a micromanipulator. Tissue was punctured at 15 cm H2O (left lateral decubitus) system pressure, and leak was measured at 25 cm H2O (semisitting) pressure. Leak rates and trauma were compared for the following: (1) six different epidural needles at 90 degrees, bevel parallel to the dural long axis; (2) 18-gauge Tuohy and 18-gauge Special Sprotte epidural needles, 30 degrees versus 90 degrees; (3) 18-gauge Tuohy, bevel perpendicular versus parallel to the dural long axis.

RESULTS

With the 90 degrees puncture, bevel parallel, the greatest leak occurred with a 17-gauge Hustead (516 +/- 319 ml/15 min), and the smallest leak occurred with a 20-gauge Tuohy (100 +/- 112 ml/15 min; P = 0.0018). A 20-gauge Tuohy puncture led to statistically significant reductions in leak (P value range, 0.0001-0.0024) compared with all needles except the Special Sprotte. With the 30 degrees versus 90 degrees angle, 30 degrees punctures with an 18-gauge Tuohy produced nonstatistically significant leak reductions compared with the 18-gauge Tuohy at 90 degrees. The puncture angle made no difference for the Special Sprotte. Nonsignificant reductions were found for the Special Sprotte compared with the Tuohy. With the 18-gauge Tuohy bevel orientation, perpendicular orientation produced nonstatistically significant reductions in leak compared with parallel orientation.

CONCLUSIONS

Cerebrospinal fluid leak after puncture was influenced most by epidural needle gauge. Leak rate was significantly less for the 20-gauge Tuohy needle.

摘要

背景

硬膜外穿刺针的设计、角度及斜面方向对穿刺后脑脊液漏的影响尚无报道。本研究使用硬脊膜囊模型检测这些因素对漏液率的影响，并通过扫描电子显微镜观察硬膜损伤情况。

方法

将人类尸体的硬脊膜安装在圆柱形模型上，使用显微操作器用硬膜外穿刺针进行穿刺。在15 cm H₂O（左侧卧位）系统压力下穿刺组织，并在25 cm H₂O（半坐位）压力下测量漏液情况。比较以下情况的漏液率和损伤程度：（1）六种不同的硬膜外穿刺针在90度、斜面与硬脊膜长轴平行时的情况；（2）18号Tuohy针和18号Special Sprotte针在30度与90度时的情况；（3）18号Tuohy针，斜面垂直与平行于硬脊膜长轴时的情况。

结果

在90度穿刺、斜面平行时，17号Hustead针漏液最多（516±319 ml/15分钟），20号Tuohy针漏液最少（100±112 ml/15分钟；P = 0.0018）。与除Special Sprotte针外的所有穿刺针相比，20号Tuohy针穿刺导致的漏液在统计学上显著减少（P值范围为0.0001 - 0.0024）。在30度与90度角度比较时，18号Tuohy针在30度穿刺时与90度穿刺相比，漏液减少无统计学意义。Special Sprotte针的穿刺角度无差异。与Tuohy针相比，Special Sprotte针漏液减少不显著。在18号Tuohy针斜面方向比较中，垂直方向与平行方向相比，漏液减少无统计学意义。