Sharma B, Gupta S, Jain N, Handoo A, Sood J
Department of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, India.
Anaesth Intensive Care. 2011 Sep;39(5):914-8. doi: 10.1177/0310057X1103900518.
The problem of tissue coring exists despite the availability of smaller gauge spinal needles with special tip designs. The aim of the study was to test the hypotheses that a) subarachnoid block given as a part of a combined spinal epidural intervention by needle-through-needle technique introduces a lesser number of epithelial cells into the subarachnoid space compared to isolated subarachnoid block, and b) after lumbar puncture, the initial few drops of cerebrospinal fluid from the spinal needle will have a higher number of epithelial cells than the subsequent sample. One hundred and seven patients of American Society of Anesthesiologists physical status I to III undergoing infra-umbilical surgery were enrolled. Seven patients were excluded from the study and the rest divided into two groups to receive either combined spinal epidural anaesthesia (group A) or isolated subarachnoid anaesthesia, unaided by an introducer (group B). The two groups were compared for the presence of epithelial cells in cerebrospinal fluid. The initial four to six drops of cerebrospinal fluid (sample 1) were collected, the next four to six drops discarded and the following four to six drops (sample 2) collected. The incidence of coring was 96% in group A and 88% in group B (P = 0.142). The median (interquartile range) number of cells in group A, for samples 1 and 2 was 6 (3 to 12.5) and 6 (3 to 10); and in group B, 3.5 (1 to 10) and 4 (1 to 8) respectively. Significant tissue coring was observed with both techniques. Discarding eight to 12 drops of cerebrospinal fluid did not help in reducing the epithelial cell load.
尽管有特殊针尖设计的小口径脊髓穿刺针，但组织取芯问题仍然存在。本研究的目的是检验以下假设：a）与单独的蛛网膜下腔阻滞相比，通过针内针技术进行的联合脊髓硬膜外干预中作为一部分给予的蛛网膜下腔阻滞引入蛛网膜下腔的上皮细胞数量更少；b）腰椎穿刺后，脊髓穿刺针最初的几滴脑脊液中的上皮细胞数量将高于随后的样本。招募了107例美国麻醉医师协会身体状况I至III级、接受脐下手术的患者。7例患者被排除在研究之外，其余患者分为两组，分别接受联合脊髓硬膜外麻醉（A组）或无引导器辅助的单独蛛网膜下腔麻醉（B组）。比较两组脑脊液中上皮细胞的存在情况。收集最初的四至六滴脑脊液（样本1），丢弃接下来的四至六滴，然后收集随后的四至六滴（样本2）。A组的取芯发生率为96%，B组为88%（P = 0.142）。A组样本1和样本2的细胞中位数（四分位间距）分别为6（3至12.5）和6（3至10）；B组分别为3.5（1至10）和4（1至8）。两种技术均观察到明显的组织取芯。丢弃八至十二滴脑脊液无助于减少上皮细胞负荷。
