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对择期剖宫产的孕妇在侧卧位和坐位时进行超声引导下的腰椎蛛网膜下腔评估。

Ultrasound-guided evaluation of the lumbar subarachnoid space in lateral and sitting positions in pregnant patients to receive elective cesarean operation.

作者信息

Gulay Ucarli, Meltem Turkay, Nadir Sinikoglu Sitki, Aysin Alagol

机构信息

Ucarli Gulay, Medical Doctor, Department of Anesthesiology and Reanimation, Ardahan State Hospital, Turkey.

Turkay Meltem, Medical Doctor, Bagcilar Training and Research Hospital.

出版信息

Pak J Med Sci. 2015 Jan-Feb;31(1):76-81. doi: 10.12669/pjms.311.5647.

DOI:10.12669/pjms.311.5647
PMID:25878618
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4386161/
Abstract

BACKGROUND AND OBJECTIVE

The aim was to compare visibility of the spinal space in sitting and lateral positions, number of attempts, spinal needle depth, skin-dura mater distance and the possible complications; in application of spinal anesthesia, using ultrasound in pregnant patients scheduled to receive elective cesarean operations.

METHODS

The study was conducted prospective-randomly after receiving approval from the ethics committee and the patients' permission. ASA I-II 50 pregnant patients were divided into two groups. The patients in Group SP were those placed in a sitting position and the patients in Group LP were those placed in a lateral position. In both groups, the skin-dura mater distance was recorded through an out-of plane technique accompanied by ultrasound. The depth of the spinal needle was measured. The number of attempts, the level of attempts recorded. The degree of visibility of the vertebral space was observed through ultrasound and was numerically scored. Intraoperative and postoperative complications were recorded.

RESULTS

There was no difference between the number of attempts, Modified Bromage Scale and mean measurements of skin-dura mater distance observed through ultrasound. The mean needle depths of Group LP were statistically found significantly higher than Group SP (p=0.002).

CONCLUSION

Our study supports the notion that access to the skin-dura mater distance is longer in the lateral decubitus position when skin-dura mater distance is evaluated by measuring needle depth.

摘要

背景与目的

目的是比较在计划接受择期剖宫产手术的孕妇中应用脊髓麻醉时,坐位和侧卧位下脊髓腔的可视性、穿刺尝试次数、脊髓穿刺针深度、皮肤至硬脊膜的距离以及可能的并发症。

方法

在获得伦理委员会批准和患者同意后,前瞻性随机开展本研究。50例ASA I-II级孕妇被分为两组。SP组患者取坐位,LP组患者取侧卧位。两组均通过超声引导下的平面外技术记录皮肤至硬脊膜的距离。测量脊髓穿刺针的深度。记录穿刺尝试次数及穿刺水平。通过超声观察椎间隙的可视程度并进行数字评分。记录术中及术后并发症。

结果

穿刺尝试次数、改良布罗玛格评分以及通过超声观察到的皮肤至硬脊膜距离的平均测量值之间无差异。统计学发现LP组的平均穿刺针深度显著高于SP组(p = 0.002)。

结论

我们的研究支持这样一种观点,即当通过测量穿刺针深度评估皮肤至硬脊膜距离时,侧卧位时该距离更长。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6ac1/4386161/d4d3e031a3b4/pjms-31-076-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6ac1/4386161/fa57d6c85705/pjms-31-076-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6ac1/4386161/d4d3e031a3b4/pjms-31-076-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6ac1/4386161/fa57d6c85705/pjms-31-076-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6ac1/4386161/d4d3e031a3b4/pjms-31-076-g002.jpg

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本文引用的文献

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J Pak Med Assoc. 2013 Jan;63(1):11-5.
2
Intrathecal clonidine as an adjuvant to hyperbaric bupivacaine in patients undergoing inguinal herniorrhaphy: A randomized double-blinded study.鞘内注射可乐定作为高压布比卡因辅助用药用于腹股沟疝修补术患者:一项随机双盲研究。
J Anaesthesiol Clin Pharmacol. 2013 Jan;29(1):66-70. doi: 10.4103/0970-9185.105804.
3
Assessing the depth of the subarachnoid space by ultrasound.通过超声评估蛛网膜下腔的深度。
Rev Bras Anestesiol. 2012 Jul;62(4):520-30. doi: 10.1016/S0034-7094(12)70150-2.
4
The distance from the skin to the epidural and subarachnoid spaces in parturients scheduled for caesarean section.产妇行剖宫产术时皮肤至硬膜外腔和蛛网膜下腔的距离。
Minerva Anestesiol. 2011 Feb;77(2):154-9. Epub 2010 Nov 24.
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Ultrasound guidance for neuraxial analgesia and anesthesia in obstetrics: a quantitative systematic review.超声引导在产科中的神经轴阻滞镇痛和麻醉中的应用:一项定量系统评价。
Ultraschall Med. 2012 Dec;33(7):E132-E137. doi: 10.1055/s-0029-1245724. Epub 2010 Nov 15.
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Use of the ultrasound to determine the level of lumbar puncture in pregnant women.使用超声确定孕妇腰椎穿刺的水平。
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