实时荧光透视引导下经胸硬膜外导管插入的血管内插入发生率。
Incidence of intravascular insertion in thoracic epidural catheterization by using real time fluoroscopy.
机构信息
Department of Anesthesiology and Pain Medicine, School of Medicine, Keimyung University, Daegu, Korea.
出版信息
Korean J Anesthesiol. 2012 Mar;62(3):251-5. doi: 10.4097/kjae.2012.62.3.251. Epub 2012 Mar 21.
BACKGROUND
Epidural analgesia is commonly used to provide several types of pain relief. Although this technique has been widely used with many advantages, currently the complications appear to be increasing. Especially, inadvertent intravascular cannulation and intravascular local anesthetic administration can lead to fatal consequences.
METHODS
Data was collected on 296 patients undergoing elective thoracic or abdominal surgery. Two detection methods were utilized to confirm the epidural intravascular cannulation; flashback and aspiration of indwelling catheter, and injection of a contrast agent through the catheter under fluoroscopy were used to guide the placement of the catheter and to examine the intravascular cannulation.
RESULTS
Epidural intravascular cannulation was reported in 4 out of 296 cases (1.4%), and 1 patient underwent subdural cannulation. Among the 4 cases of epidural intravascular cannulation, two were confirmed by the flashback and aspiration methods, while the remaining cases were only detected by real time fluoroscopy.
CONCLUSIONS
In this study, inadvertent epidural intravascular cannulation occurred by as much as 1.4% of thoracic epidural catheterization. Utilizing real time fluoroscopy in addition to flashback and aspiration can enhance the sensitivity of detection.
背景
硬膜外镇痛常用于提供多种类型的止痛。尽管该技术已广泛应用，具有许多优点，但目前并发症似乎在增加。特别是，意外的血管内套管针插入和血管内局部麻醉剂给药可能导致致命后果。
方法
对 296 例择期行胸腹部手术的患者进行了数据收集。采用两种检测方法确认硬膜外血管内套管针插入：留置导管的回血和抽吸，以及在透视引导下通过导管注射造影剂，以指导导管放置和检查血管内套管针插入情况。
结果
在 296 例患者中，有 4 例（1.4%）报告硬膜外血管内套管针插入，其中 1 例发生硬膜下套管针插入。在 4 例硬膜外血管内套管针插入中，有 2 例通过回血和抽吸方法确认，其余病例仅通过实时透视检测到。
结论
在本研究中，胸段硬膜外导管插入的硬膜外血管内套管针插入发生率高达 1.4%。除了回血和抽吸外，实时透视的应用可以提高检测的灵敏度。
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