超声实时引导腰硬联合麻醉在老年患者股骨近端螺旋刀片抗旋髓内钉手术中的应用
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摘要
目的探讨超声实时引导腰硬联合麻醉技术在老年患者股骨近端螺旋刀片抗旋髓内钉(PFNA)手术中应用的可行性和应用前景。方法研究对象选取该院2016年12月-2018年5月收治行下肢手术老年患者共80例,以随机数字表法分为A组(40例)、B组(40例),每组各40例,A组为试验组(行超声实时引导),B组为对照组(行传统体表标志定位及阻力消失法)。记录两组麻醉前准备时间、穿刺时间、麻醉相关并发症和穿刺次数。结果超声实时引导组麻醉准备时间、首次穿刺成功率均高于传统定位盲探穿刺组(P <0.05);超声实时引导组置管出血、神经刺激征、下肢感觉异常、术后腰痛并发症均显著低于传统定位盲探穿刺组(P <0.05)。结论超声实时引导腰硬联合麻醉能增加老年患者PFNA手术的麻醉质量和满意度,提高一次穿刺成功率,并减少麻醉后并发症。
[Objective] To investigate the feasibility and prospect of ultrasound real-time guided combined spinal and epidural anesthesia in the operation of proximal femoral nail antirotation(PFNA) in elderly patients.[Methods] Eighty patients undergoing PFNA surgery were chosen in the period from December 2016 to May 2018 in our hospital and randomly divided into two groups including group A(40 cases), group B(40 cases). Group A was the experimental group(ultrasound real-time guidance) and group B the control group(classical methods which locates the epidural space by surface landmarks and loss-of-resistance). The time of preanesthetic preparation, time of operation, complications and attempt times were recorded.[Results] The localization-time of preanesthesia in the ultrasound group, and the successful rate of first puncture in the ultrasound group were higher than those of the surface group, with significant difference(P<0.05). The incidence rate of complications such as catheter bleeding, nerve stimulation signs, paresthesia of the lower extremities and postoperative low back pain in the ultrasound group were significantly lower than those in the surface group,with significant difference(P <0.05).[Conclusion] Ultrasonic real-time guidance to combined spinal and epidural anesthesia can increase the anesthesia quality and satisfaction of PFNA surgery in elderly patients, improve the success rate of a puncture, and reduce complications after anesthesia.
[Objective] To investigate the feasibility and prospect of ultrasound real-time guided combined spinal and epidural anesthesia in the operation of proximal femoral nail antirotation(PFNA) in elderly patients.[Methods] Eighty patients undergoing PFNA surgery were chosen in the period from December 2016 to May 2018 in our hospital and randomly divided into two groups including group A(40 cases), group B(40 cases). Group A was the experimental group(ultrasound real-time guidance) and group B the control group(classical methods which locates the epidural space by surface landmarks and loss-of-resistance). The time of preanesthetic preparation, time of operation, complications and attempt times were recorded.[Results] The localization-time of preanesthesia in the ultrasound group, and the successful rate of first puncture in the ultrasound group were higher than those of the surface group, with significant difference(P<0.05). The incidence rate of complications such as catheter bleeding, nerve stimulation signs, paresthesia of the lower extremities and postoperative low back pain in the ultrasound group were significantly lower than those in the surface group,with significant difference(P <0.05).[Conclusion] Ultrasonic real-time guidance to combined spinal and epidural anesthesia can increase the anesthesia quality and satisfaction of PFNA surgery in elderly patients, improve the success rate of a puncture, and reduce complications after anesthesia.
引文
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[7]Balki M.Locating the epidural space in obstetric patientsultrasound a useful tool:continuing professional development.Can J Anaesth,2010,57(12):1111-1126.
[8]Ezri T,Zahalka I,Zebeeda D,et al.Similar incidence of hypotension with combined spinal-epidural alone for knee arthroplasty[J].Can J Anaesth,2006,53(2):139-145.
[9]Neuman MD,Silber JH,Elkassabany NM,et al.Comparative effectiveness of regional versus general anesthesia for hip fracture surgery in adults[J].Anesthesiology,2012,117(1):72-92.DOI:10.1097/ALN.0b013e3182545e7c.
[10]Grau T,Leipold RW,Conradi R,et al.Ultrasound imaging facilitates localization of the epidural space during combined spinal and epidural anesthesia[J].Reg Anesth Pain Med,2001,26(1):64-67.DOI:10.1053/rapm.2001.19633.
[11]O'Donnell D,Prasad A,Perlas A.Ultrasound-assisted spinal anesthesia in obese patients[J].Can J Anesth,2009,56(12):982-983.DOI:10.1007/s12630-009-9179-6.
[12]Aylott CE,Puna R,Robertson PA,et al.Spinous process morphology:the effect of ageing through adulthood on spinous process size and relationship to sagittal alignment[J].Eur Spine J,2012,21(5):1007-1012.DOI:10.1007/s00586-011-2029-6.
[13]Scapinelli R.Morphological and functional changes of the lumbar spinous processes in the elderly[J].Surg Radiol Anat,1989,119(2):129-133.
[14]Auroy Y,Narchi P,Messiah A,et al.Serious complications related to regional anesthesia:results of a prospective survey in France[J].Anesthesiology,1997,87(3):479-486.
[15]Karmakar MK,Li X,Ho AM,et al.Real-time ultrasoundguided paramedian epidural access:evaluation of novel in-plane technique[J].Br J Anaesth,2009,102(6):845-854.
[2]Mahne AT,Rioja E,Marais HJ,et al.Clinical and pharmacokinetic effects of regional or general anaesthesia on intravenous regional limb perfusion with amikacin in horses[J].Equine Veterinary Journal,2014,46(3):375-379.
[3]周子戎,汪春英.腰硬联合麻醉在80岁以上高危老年病人骨科手术中的应用[J].临床麻醉学杂志,2008,24(1):40-41.
[4]张维娥,邵雪梅.腰硬联合麻醉在高龄患者半髋关节置换术中的应用[J].临床麻醉学杂志,2011,27(2):203.
[5]Weed J,Finkel K,Beach ML,et al.Spinal anesthesia for orthopedic surgery:a detailed video assessment of quality.Reg Anesth Pain Med,2011,36(1):51-55.
[6]Tessler MJ,Kardash K,Wahba RM,et al.The performance of spinal anesthesia is marginally more difficult in the elderly.Reg Anesth Pain Med,1999,24(2):126-130.
[7]Balki M.Locating the epidural space in obstetric patientsultrasound a useful tool:continuing professional development.Can J Anaesth,2010,57(12):1111-1126.
[8]Ezri T,Zahalka I,Zebeeda D,et al.Similar incidence of hypotension with combined spinal-epidural alone for knee arthroplasty[J].Can J Anaesth,2006,53(2):139-145.
[9]Neuman MD,Silber JH,Elkassabany NM,et al.Comparative effectiveness of regional versus general anesthesia for hip fracture surgery in adults[J].Anesthesiology,2012,117(1):72-92.DOI:10.1097/ALN.0b013e3182545e7c.
[10]Grau T,Leipold RW,Conradi R,et al.Ultrasound imaging facilitates localization of the epidural space during combined spinal and epidural anesthesia[J].Reg Anesth Pain Med,2001,26(1):64-67.DOI:10.1053/rapm.2001.19633.
[11]O'Donnell D,Prasad A,Perlas A.Ultrasound-assisted spinal anesthesia in obese patients[J].Can J Anesth,2009,56(12):982-983.DOI:10.1007/s12630-009-9179-6.
[12]Aylott CE,Puna R,Robertson PA,et al.Spinous process morphology:the effect of ageing through adulthood on spinous process size and relationship to sagittal alignment[J].Eur Spine J,2012,21(5):1007-1012.DOI:10.1007/s00586-011-2029-6.
[13]Scapinelli R.Morphological and functional changes of the lumbar spinous processes in the elderly[J].Surg Radiol Anat,1989,119(2):129-133.
[14]Auroy Y,Narchi P,Messiah A,et al.Serious complications related to regional anesthesia:results of a prospective survey in France[J].Anesthesiology,1997,87(3):479-486.
[15]Karmakar MK,Li X,Ho AM,et al.Real-time ultrasoundguided paramedian epidural access:evaluation of novel in-plane technique[J].Br J Anaesth,2009,102(6):845-854.