Shenkman Ze'ev, Rathaus Valeria, Jedeikin Robert, Konen Osnat, Hoppenstein David, Snyder Mitchell, Freud Enrique
Department of Anesthesia and Critical Care Medicine, Meir Hospital, Kfar Saba, Israel.
Can J Anaesth. 2004 Feb;51(2):160-2. doi: 10.1007/BF03018776.
Spinal anesthesia can be technically challenging in young infants. We studied whether the distance between the skin and the lumbar subarachnoid space in premature and former-premature young infants could be predicted prior to lumbar puncture.
The distance from skin entry point to tip of the spinal needle was measured using a caliper after lumbar spinal anesthesia at the L4-5 interspace. This distance was correlated to the patient's weight, postconceptual age and lumbar ultrasonographic measurement of the skin-to-subarachnoid space and predictive statistical models were sought.
Thirty-five premature or former-premature infants were studied. Three models were examined: all three independent variables, weight and postconceptual age only, and weight only. The model selected contained the weight and postconceptual age, because it had the highest value for adjusted R squared, as well as the lowest value for the mean squared error. Adding the ultrasonic measurement to the model worsened the results. The statistical model that described the depth of the subarachnoid space at the L4-5 level was Y = 13.19 + 0.0026 x W - 0.12 x PCA, where Y is the distance (mm) from the skin to the subarachnoid space, W is the patient's weight (g) and PCA is the postconceptual age (weeks). Adjusted R squared was 0.72, mean square error was 2.63 and P < 10(-9).
The distance between the skin and the subarachnoid space at the level of L4-5 interspace can be predicted using a statistical model based on the infant's weight and postconceptual age. Spinal ultrasound has no value in L4-5 subarachnoid space depth prediction.
在年幼婴儿中实施脊髓麻醉在技术上可能具有挑战性。我们研究了在腰椎穿刺前是否能够预测早产及曾早产的年幼婴儿皮肤与腰蛛网膜下腔之间的距离。
在L4 - 5椎间隙进行腰段脊髓麻醉后，用卡尺测量皮肤进针点至脊髓穿刺针尖端的距离。将该距离与患者体重、孕龄及皮肤至蛛网膜下腔的腰椎超声测量值进行相关性分析，并寻求预测性统计模型。
对35例早产或曾早产的婴儿进行了研究。考察了三个模型：所有三个自变量、仅体重和孕龄以及仅体重。所选择的模型包含体重和孕龄，因为其调整后R平方值最高，且均方误差值最低。将超声测量值加入模型会使结果变差。描述L4 - 5水平蛛网膜下腔深度的统计模型为Y = 13.19 + 0.0026×W - 0.12×PCA，其中Y为皮肤至蛛网膜下腔的距离（mm），W为患者体重（g），PCA为孕龄（周）。调整后R平方为0.72，均方误差为2.63，P < 10⁻⁹。
基于婴儿体重和孕龄的统计模型可用于预测L4 - 5椎间隙水平皮肤与蛛网膜下腔之间的距离。脊髓超声在预测L4 - 5蛛网膜下腔深度方面无价值。
