困难骶管硬膜外阻滞预测模型的建立。
Establishment of Difficult Caudal Epidural Blockade Prediction Model.
作者信息
Xie Guohao, Zhao Jialian, Chu Lihua, Song Shengwen, Wang Ya, Lai Dengming, Cheng Baoli, Fang Xiangming
机构信息
Departments of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
Departments of Anesthesiology, The Children's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
出版信息
Evid Based Complement Alternat Med. 2022 Nov 4;2022:2037904. doi: 10.1155/2022/2037904. eCollection 2022.
BACKGROUND
We aimed to develop a predictive difficult caudal epidural blockade (pDCEB) model when ultrasound was not available and verified the role of ultrasound in difficult caudal epidural blockade (CEB).
METHODS
From October 2018 to March 2019, this study consisted of three phases. First, we prospectively enrolled 202 patients scheduled to undergo caudal epidural anesthesia and assessed risk factors by binary logistic regression to develop the predictive scoring system. Second, we enrolled 87 patients to validate it. The receiver operating characteristic (ROC) curve was used to evaluate the performance of the prediction model. Youden-index was used to determine the cut-off value. Third, we enrolled 68 patients with a high risk of difficult CEB (pDCEB score ≥3) and randomized them into ultrasound and landmark groups to verify the role of ultrasound.
RESULT
The rate of difficult CEB was 14.98% overall 289 patients. We found a correlation between unclear palpation of the sacral hiatus (OR 9.688) and cornua (OR 4.725), the number of the sacral hiatus by palpation ≥1 (OR 4.451), and history of difficult CEB (OR 39.282) with a higher possibility of difficult CEB. The area under the receiver operating characteristic curve of the pDCEB model involving the aforementioned factors was 0.889 (95% CI, 0.827-0.952) in the development cohort and 0.862 (95% CI, 0.747-0.977) in the validation cohort. For patients with a pDCEB score ≥3, a preprocedure ultrasound scan could reduce the incidence of difficult CEB (55.56% in the Landmark group vs. 9.38% in the ultrasound group, < 0.001).
CONCLUSION
This novel pDCEB score, which takes into account palpation of the sacral hiatus/cornua, number of the sacral hiatus by palpation ≥1, and history of difficult CEB, showed a good predictive ability of difficult CEB. The findings suggested that performing an ultrasound scan is essential for patients with a pDCEB score ≥3. Trial registration: No: ChiCTR1800018871, Site URL: https://www.chictr.org.cn/edit.aspx?pid=31875&htm=4; Principal investigator: Jialian Zhao, Date of registration: 2018.10.14.
背景
我们旨在开发一种在无法使用超声时预测困难骶管硬膜外阻滞（pDCEB）的模型，并验证超声在困难骶管硬膜外阻滞（CEB）中的作用。
方法
2018年10月至2019年3月，本研究包括三个阶段。首先，我们前瞻性纳入202例计划接受骶管硬膜外麻醉的患者，并通过二元逻辑回归评估危险因素以建立预测评分系统。其次，我们纳入87例患者进行验证。采用受试者工作特征（ROC）曲线评估预测模型的性能。用约登指数确定临界值。第三，我们纳入68例具有高难度CEB风险（pDCEB评分≥3）的患者，并将他们随机分为超声组和体表标志组，以验证超声的作用。
结果
289例患者中，困难CEB的总体发生率为14.98%。我们发现骶裂孔触诊不清（OR 9.688）、角（OR 4.725）、触诊骶裂孔数量≥1个（OR 4.451）以及既往困难CEB史（OR 39.282）与发生困难CEB的可能性较高相关。在开发队列中，包含上述因素的pDCEB模型的受试者工作特征曲线下面积为0.889（95%CI，0.827 - 0.952），在验证队列中为0.862（95%CI，0.747 - 0.977）。对于pDCEB评分≥3的患者，术前超声扫描可降低困难CEB的发生率（体表标志组为55.56%，超声组为9.38%，P<0.001）。
结论
这种新的pDCEB评分，考虑了骶裂孔/角的触诊、触诊骶裂孔数量≥1个以及既往困难CEB史，对困难CEB具有良好的预测能力。研究结果表明，对于pDCEB评分≥3的患者，进行超声扫描至关重要。试验注册：编号：ChiCTR1800018871，网站网址：https://www.chictr.org.cn/edit.aspx?pid=31875&htm=4；主要研究者：赵家连，注册日期：2018.10.14。
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