Li Lei, Tao Weichen, Cai Xue
Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang, China.
Front Surg. 2022 Apr 26;9:874143. doi: 10.3389/fsurg.2022.874143. eCollection 2022.
Emergency patients are in severe and urgent condition. If the patient is obese, the traditional lumbar puncture method is more difficult. This study was to observe the comparison of ultrasound-guided and landmark-guided lumbar puncture for obese patients in the emergency department.
Sixty patients suspected of intracranial infection, subarachnoid hemorrhage, and intraventricular hemorrhage from January 2018 to June 2020 were selected in the Department of Emergency Medicine, Shengjing Hospital of China Medical University. They were randomly assigned to two groups according to the order of enrollment: Group A (Landmark-guided group, = 30) and Group B (Ultrasound-guided group, = 30). Follow-up assessments were performed to observe lumbar puncture time, the number of bloody CSF, Visual Analog Scale (VAS), the complications, and satisfaction.
Compared with group A, group B had less lumbar puncture time, lower puncture attempts, and a higher first puncture success rate ( <0.05). In group B, the number of bloody CSF was less ( <0.05), postprocedural low back pain was less ( <0.05), intraprocedural sciatic nerve irritation and postprocedural paresthesia were less, but the difference was not statistically significant ( > 0.05). Compared with group A, the postprocedural VAS in group B was lower, and the difference was statistically significant ( <0.05). The total satisfaction of group A and group B was 60.0 and 86.7%, respectively. The total satisfaction of group B was higher than that of group A ( <0.05).
Ultrasound-guided lumbar puncture can be used for obese patients with difficulty in the lumbar puncture. It is worthy of clinical application and promotion.
急诊患者病情严重且紧急。若患者肥胖，传统腰椎穿刺方法难度更大。本研究旨在观察超声引导与体表定位引导下腰椎穿刺在急诊科肥胖患者中的对比情况。
选取2018年1月至2020年6月在中国医科大学附属盛京医院急诊科就诊的60例疑似颅内感染、蛛网膜下腔出血和脑室内出血的患者。按入组顺序将其随机分为两组：A组（体表定位引导组，n = 30）和B组（超声引导组，n = 30）。进行随访评估，观察腰椎穿刺时间、血性脑脊液数量、视觉模拟评分（VAS）、并发症及满意度。
与A组相比，B组腰椎穿刺时间更短、穿刺尝试次数更少、首次穿刺成功率更高（P<0.05）。B组血性脑脊液数量更少（P<0.05），术后腰痛更少（P<0.05），术中坐骨神经刺激及术后感觉异常更少，但差异无统计学意义（P>0.05）。与A组相比，B组术后VAS更低，差异有统计学意义（P<0.05）。A组和B组的总满意度分别为60.0%和86.7%。B组的总满意度高于A组（P<0.05）。
超声引导下腰椎穿刺可用于腰椎穿刺困难的肥胖患者。值得临床应用和推广。
