超声测量的后复合体长度与深度比值对择期剖宫产困难椎管内麻醉预测效果的前瞻性队列研究。

Performance of the ratio of posterior complex length to depth measured by ultrasound as a predictor of difficult spinal anesthesia for elective cesarean delivery: a prospective cohort study.

机构信息

Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Hefei, 230022, China.

Department of Anesthesiology, Anhui Maternal and Child Health Care Hospital, Maternal and Child Health Care Hospital of Anhui Medical University, Hefei, China.

出版信息

J Anesth. 2024 Dec;38(6):787-795. doi: 10.1007/s00540-024-03394-6. Epub 2024 Aug 20.

DOI:10.1007/s00540-024-03394-6

PMID:39164406

Abstract

PURPOSE

Ultrasound view of the interlaminar structure is likely to be associated with difficult spinal anesthesia (DSA), and a poor ultrasound view which cannot show the anterior and posterior complex predicts a difficult spinal technique. As our target site is the posterior complex, this study aimed to assess whether the ratio of posterior complex length to depth measured by ultrasound can predict DSA in cesarean delivery.

METHODS

Four anesthesiologists with 1-2 years of experience located and marked the puncture interspace using a traditional surface landmark. Subsequently, the ultrasound examiner located and measured the marked interspace via an oblique parasagittal ultrasound scan. The anesthesiologists, who were blinded to the ultrasound results, performed spinal anesthesia using a 25-gauge Whitacre spinal needle. The total number of attempts, including skin punctures and needle passes, was recorded and the DSA was defined as 10 unsuccessful attempts. A multivariable logistic regression analysis was used to determine the independent predictors, and receiver operating characteristic curves were constructed to evaluate the performance of the ratio of posterior complex length to depth for predicting DSA.

RESULTS

A total of 397 cesarean delivery parturients with successfully measured posterior complex were included in the analysis. DSA occurred in 64 parturients (16.1%). Reduced length [odds ratio (OR) = 0.010, 95% confidence interval (CI), 0.002-0.062, P < 0.001] and increased depth [OR = 6.127, 95% CI, 2.671-14.056, P < 0.001] of the posterior complex were independently predictive of DSA compared with body mass index, abdominal circumference, and palpable surface landmarks. The ratio of posterior complex length to depth for predicting DSA had an area under the curve of 0.86 (95% CI, 0.82-0.90). The optimal cutoff was 0.23, with a sensitivity of 86% (95% CI, 74-93%) and specificity of 72% (95% CI, 67-77%).

CONCLUSION

The ratio of posterior complex length to depth measured by ultrasound demonstrated a considerable accuracy in predicting DSA for inexperienced anesthesiologists. A higher ratio at ultrasound is an indication to evaluate the optimal puncture body position and interspace in the clinic practice.

CLINICAL TRIAL REGISTRATION

ChiCTR2200065171 https://www.chictr.org.cn/showproj.html?proj=180855.

摘要

目的

椎间层结构的超声视图可能与困难的脊髓麻醉（DSA）有关，而无法显示前复合体和后复合体的不良超声视图预测脊髓技术困难。由于我们的目标部位是后复合体，因此本研究旨在评估通过超声测量的后复合体长度与深度之比是否可以预测剖宫产中的 DSA。

方法

4 位具有 1-2 年经验的麻醉师使用传统的表面标志定位并标记穿刺间隙。随后，超声检查者通过斜矢状超声扫描定位并测量标记的间隙。麻醉师在进行脊髓麻醉时使用 25 号 Whitacre 脊髓针，他们对超声结果一无所知。记录总穿刺次数（包括皮肤穿刺和针次），并将 DSA 定义为 10 次不成功的尝试。使用多变量逻辑回归分析确定独立预测因子，并构建接收者操作特征曲线以评估后复合体长度与深度之比预测 DSA 的性能。

结果

共有 397 例成功测量后复合体的剖宫产产妇纳入分析。64 例产妇（16.1%）发生 DSA。与体重指数、腹围和可触及的体表标志相比，后复合体长度降低[比值比（OR）=0.010，95%置信区间（CI），0.002-0.062，P<0.001]和深度增加[OR=6.127，95%CI，2.671-14.056，P<0.001]是 DSA 的独立预测因子。用于预测 DSA 的后复合体长度与深度之比的曲线下面积为 0.86（95%CI，0.82-0.90）。最佳截断值为 0.23，灵敏度为 86%（95%CI，74-93%），特异性为 72%（95%CI，67-77%）。