Alagoz Ali, Sazak Hilal, Tunc Mehtap, Ulus Fatma, Kokulu Serdar, Pehlivanoglu Polat, Sahin Saziye
Department of Anesthesiology and Reanimation, Ataturk Chest Disease and Thoracic Surgery Training and Research Hospital, Ankara, Turkey.
Department of Anesthesiology and Reanimation, Ataturk Chest Disease and Thoracic Surgery Training and Research Hospital, Ankara, Turkey.
Braz J Anesthesiol. 2016 Jan-Feb;66(1):1-6. doi: 10.1016/j.bjane.2014.07.010. Epub 2014 Oct 27.
In this study, we aimed to clarify the importance of residency grade and other factors which influence the success of thoracic epidural catheterization in thoracotomy patients.
After the ethical committee approval, data were recorded retrospectively from the charts of 415 patients. All patients had given written informed consent. The thoracic epidural catheterization attempts were divided into two groups as second-third year (Group I) and fourth year (Group II) according to residency grade. We retrospectively collected demographic data, characteristics of thoracic epidural catheterization attempts, and all difficulties and complications during thoracic epidural catheterization.
Overall success rate of thoracic epidural catheterization was similar between the groups. Levels of catheter placement, number and duration of thoracic epidural catheterization attempts were not different between the groups (p>0.05). Change of needle insertion level was statistically higher in Group II (p=0.008), whereas paresthesia was significantly higher in Group I (p=0.007). Dural puncture and postdural puncture headache rates were higher in Group I. Higher body mass index and level of the insertion site were significant factors for thoracic epidural catheterization failure and postoperative complication rate and those were independence from residents' experience (p<0.001, 0.005).
Body mass index and level of insertion site were significant on thoracic epidural catheterization failure and postoperative complication rate. We think that residents' grade is not a significant factor in terms overall success rate of thoracic epidural catheterization, but it is important for outcome of these procedures.
在本研究中，我们旨在阐明住院医师级别及其他影响开胸手术患者胸段硬膜外导管置入成功率的因素的重要性。
经伦理委员会批准后，从415例患者的病历中回顾性记录数据。所有患者均已签署书面知情同意书。根据住院医师级别，将胸段硬膜外导管置入尝试分为二至三年级（第一组）和四年级（第二组）。我们回顾性收集了人口统计学数据、胸段硬膜外导管置入尝试的特征以及胸段硬膜外导管置入期间的所有困难和并发症。
两组胸段硬膜外导管置入的总体成功率相似。两组之间导管置入水平、胸段硬膜外导管置入尝试的次数和持续时间无差异（p>0.05）。第二组针插入水平的改变在统计学上更高（p=0.008），而第一组感觉异常显著更高（p=0.007）。第一组硬膜穿刺和硬膜穿刺后头痛发生率更高。较高的体重指数和插入部位水平是胸段硬膜外导管置入失败和术后并发症发生率的重要因素，且与住院医师经验无关（p<0.001，0.005）。
体重指数和插入部位水平对胸段硬膜外导管置入失败和术后并发症发生率有显著影响。我们认为，就胸段硬膜外导管置入的总体成功率而言，住院医师级别不是一个重要因素，但对这些操作的结果很重要。
