Apiliogullari Seza, Duman Ates, Gok Funda, Ogun Cemile Oztin, Akillioglu Ishak
Department of Anesthesia and Intensive Care, Dr Faruk Sukan Obstetrics and Children's Hospital, Konya, Turkey.
Paediatr Anaesth. 2008 Dec;18(12):1178-82. doi: 10.1111/j.1460-9592.2008.02780.x.
There are few studies for procedural techniques of lumbar puncture (LP) for spinal anesthesia in children. There are no controlled studies on the effect of patient positioning. We designed this prospective, randomized study to compare the success rates of LP of the lateral decubitus and lateral decubitus position with a 45 degree head up tilt in children undergoing spinal anesthesia.
Study was conducted in 180 children aged between one month to twelve years. The LP was performed under general anesthesia using sevoflurane with a 26-gauge, atraumatic needle either in the standard lateral decubitus, knee-chest position (group I, n = 90) or lateral decubitus, knee-chest position with a 45 degree head up tilt (group II, n = 90). The free flow of clear cerebrospinal fluid (CSF) at first attempt was considered to evidence a successful LP.
The two groups were similar in age and weight. Total LP success rate was higher in group II than in group I (P < 0.05). When the significance between the groups was evaluated according to age, the increase in LP success rate was significant in children aged <12 months of age but not significant in children older than 12 months of age.
Because of higher success rate, lateral decubitus, knee-chest position with 45 degree head up tilt may be the preferred position for spinal anesthesia in infants.
关于儿童脊髓麻醉中腰椎穿刺（LP）操作技术的研究较少。关于患者体位影响的对照研究尚未开展。我们设计了这项前瞻性随机研究，以比较脊髓麻醉儿童采用侧卧位和头向上倾斜45度的侧卧位进行腰椎穿刺的成功率。
对180名年龄在1个月至12岁之间的儿童进行研究。在全身麻醉下使用七氟醚，用26号无创伤针在标准侧卧位、膝胸位（I组，n = 90）或头向上倾斜45度的侧卧位、膝胸位（II组，n = 90）进行腰椎穿刺。首次尝试时清亮脑脊液（CSF）自由流出被视为腰椎穿刺成功的证据。
两组在年龄和体重方面相似。II组的腰椎穿刺总成功率高于I组（P < 0.05）。当根据年龄评估组间差异时，年龄<12个月的儿童腰椎穿刺成功率增加显著，而12个月以上儿童则不显著。
由于成功率较高，头向上倾斜45度的侧卧位、膝胸位可能是婴儿脊髓麻醉的首选体位。
