Adachi Y U, Sanjo Y, Sato S
Intensive Care Unit of University Hospital, Hamamatsu University School of Medicine, Hamamatsu city, Shizuoka, Japan.
Acta Anaesthesiol Scand. 2007 Jul;51(6):731-5. doi: 10.1111/j.1399-6576.2007.01302.x. Epub 2007 Apr 10.
Epidural anaesthesia is an efficient method of providing both regional anaesthesia and post-operative pain relief. Detection of the epidural space is critical, but it is difficult to predict the depth of the epidural space. Published results are inconsistent. We retrospectively investigated the differences in the depth of the epidural space depending on the puncture site, approach type and physical findings of patients.
All surgical patients from 1994 to 2005 were included in the study and 4964 cases were analysed. The recorded distance from the needle tip to the skin surface was defined as the depth of the epidural. The differences in the depth were compared according to the puncture site, level and approach. We then searched for the factors determining the depth using multivariate regression analysis.
The depth in upper thoracic sites (T1/2-T9/10) was 5.0 (1.0) cm [mean (SD), n= 465] via the midline approach and 5.2 (1.0) cm (n= 1226) via the paramedian approach. For lumbar sites, the depth was 4.1 (0.9) cm (n= 1835) via the midline approach and 4.6 (1.0) cm (n= 298) via the paramedian approach. In the multivariate regression analysis, patient age, body weight and more cephalad puncture were significantly and positively correlated with the depth at thoracic sites.
The epidural space was deeper at upper thoracic sites than lower thoracic or lumbar sites. The depth with the paramedian approach was greater than with the midline approach at both sites. Patient age and weight were positive factors for depth.
硬膜外麻醉是提供区域麻醉和术后疼痛缓解的有效方法。硬膜外腔的检测至关重要，但难以预测硬膜外腔的深度。已发表的结果并不一致。我们回顾性研究了根据穿刺部位、进针方式和患者体格检查结果，硬膜外腔深度的差异。
纳入1994年至2005年所有手术患者，共分析4964例病例。记录的从针尖到皮肤表面的距离定义为硬膜外深度。根据穿刺部位、节段和进针方式比较深度差异。然后使用多因素回归分析寻找决定深度的因素。
上胸部（T1/2 - T9/10）部位，经中线进针深度为5.0（1.0）cm [均值（标准差），n = 465]，经旁正中进针深度为5.2（1.0）cm（n = 1226）。腰部部位，经中线进针深度为4.1（0.9）cm（n = 1835），经旁正中进针深度为4.6（1.0）cm（n = 298）。在多因素回归分析中，患者年龄、体重和更靠头侧的穿刺与胸部部位的深度显著正相关。
上胸部硬膜外腔比下胸部或腰部硬膜外腔更深。两个部位旁正中进针的深度均大于中线进针。患者年龄和体重是深度的正向影响因素。
