刘慧杰,孙 雯,李志军,黄 岩

目的：探究不同方式介导对低位蛛网膜下腔麻醉穿刺的影响。方法：随机将我院2023年6月至2023年12月行低位蛛网膜下腔穿刺麻醉的60例患者分为三组，每组各20例，A组触摸定位旁正中入路盲穿法穿刺，B组超声定位后盲穿法穿刺，C组超声实时引导下旁正中冠状斜位入路穿刺。比较三组全程操作用时、一针穿刺成功率、麻醉成功率、患者满意度及并发症。结果：操作用时对比，A组与B组无统计学差异（P＞0.05）。A组长于C组（P＜0.05）。B组与C组无统计学差异（P＞0.05）；A组一针穿刺成功率低于B、C组（P＜0.05），B组与C组无统计学差异（P＞0.05）；C组麻醉成功率高于A、B组（P＜0.05），A组与B组无统计学差异（P＞0.05）；A组患者满意度低于B、C组（P＜0.05），B组与C组无统计学差异（P＞0.05）；A组穿刺并发症高于B、C组（P＜0.05），B组与C组无统计学差异（P＞0.05）；三组均无严重并发症发生。结论：在蛛网膜下腔麻醉中，超声实时引导下旁正中冠状斜位入路穿刺可缩短全程操作用时，减少穿刺次数及穿刺并发症，提高麻醉成功率及患者满意度。

超声引导；蛛网膜下腔麻醉；穿刺；麻醉效果

[1] Qu Bo,Chen Luying,Zhang Yuling,et al.Landmark-guided versus modified ultrasound-assisted Paramedian techniques in combined spinal-epidural anesthesia for elderly patients with hip fractures: a randomized controlled trial[J].BMC Anesthesiology.2020,20(1). [2] Zhou Yilu,Chen Wei,Zhou Shuangqiong,et al.Comparison of different approaches to combined spinal epidural anesthesia (CSEA) under the guidance of ultrasound in cesarean delivery of obese patients: a randomized controlled trial[J].European journal of medical research.2021,26(1). [3] Karmakar MK . Musculoskeletal ultrasound for regional anaesthesia and pain medicine[M]. 2nd ed. Hong Kong:The Chinese University of Hong Kong, 2016. [4] Park, Sun-Kyung,Yoo, Seokha,Kim, Won Ho,et al.Ultrasound-assisted vs. landmark-guided paramedian spinal anaesthesia in the elderly A randomised controlled trial[J].European journal of anaesthesiology.2019,36(10).763-771. [5] Harsha.Narkhede,Deepa.Kane,Viral.Parekh,et al.A cohort study of anatomical landmark-guided midline versus pre-procedure ultrasound-guided midline technique of spinal anesthesia in elderly patients undergoing orthopedic surgery[J].Journal of Anaesthesiology, Clinical Pharmacology.2019,35(4).522-527. [6] 张二飞,王茜,麻慧慧,等.旁正中入路穿刺法在高龄患者髋部手术腰硬联合麻醉中的应用[J].中国现代医学杂志.2020,(2). [7] Chong SE , Mohd Nikman A , Saedah A ,et al. Real-time ultrasound-guided paramedian spinal anaesthesia: evaluation of the efficacy and the success rate of single needle pass[J]. Br J Anaesth, 2017,118(5):799-801. [8] WANG L.,CHANG R.,CHEN X..Impact of Intraspinal Nerve Block Anesthesia on Intrapartum Fever and the Neonate[J].Evidence-based complementary and alternative medicine:eCAM,2022,2022(Pt.16):2600755. [9] Ramteke JH，Sahu DK，Sonawane A,et al. New technology: Handheld ultrasound- assisted localization of epidural space[J]. Saudi J Anaesth, 2018, 12 (2): 365-367. [10] Bingdong Tao,Kun Liu,Mengmeng Ding,et al.Ultrasound increases the success rate of spinal needle placement through the epidural needle during combined spinal-epidural anaesthesia[J].European journal of anaesthesiology.2021,38(3).251-258. [11] 贺腾,马玉姗.超声引导用于脊柱侧弯矫形术后孕妇硬膜外分娩镇痛1例[J].中华医学杂志.2022,102(11). [12] 单涛,韩流,葛德高,等.超声引导下髋关节囊周围神经阻滞联合椎管内麻醉在老年患者全髋关节置换术中的应用[J].临床麻醉学杂志.2021,(5). [13] 胡瑞良.超声在产科椎管内麻醉的应用进展[J].中国微创外科杂志.2023,23(4). [14] Ripolles-Melchor, Javier,Abad-Motos, Ane,Diez-Remesal, Yolanda,et al.Association Between Use of Enhanced Recovery After Surgery Protocol and Postoperative Complications in Total Hip and Knee Arthroplasty in the Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol in Elective Total Hip and Knee Arthroplast[J].JAMA surgery.2020,155(4).e196024-e196024. [15] Hruslinski, Jennifer,Menio, Diane A.,Hymes, Robert A.,等.Engaging patients as partners in a multicentre trial of spinal versus general anaesthesia for older adults[J].British journal of anaesthesia.2021,126(2).395-403. [16] 金昕煜,徐铭军.超声技术在椎管内麻醉的应用现状[J].中国临床医生杂志.2020,(10). [17] 郭敏,王云,王雷,等.改良超声引导椎管内穿刺技术用于脊柱结构异常患者的麻醉1例[J].国际麻醉学与复苏杂志.2019,(10). [18] XU,YI,FANG,JIANSHENG,XIA,YANZHI,et al.Ultrasound-Guided Femoral Nerve Block Anesthesia for Tibiofibular Fracture[J].Journal of Medical Imaging and Health Informatics,2020,10(6):1333-1337. [19] Todorov, Plamen,Nestorova, Rodina,Batalov, Anastas..Diagnostic value of musculoskeletal ultrasound in patients with low back pain - a review of the literature.[J].Medical ultrasonography.2018,20(1).80-87. [20] 韩斌,徐铭军,白云波.超声定位技术在重度肥胖产妇行椎管内麻醉中的应用[J].中国医药导报.2021,(7). [21] Gueziri, Houssem-Eddine,Drouin, Simon,Yan, Charles X. B.,等.Toward real-time rigid registration of intra-operative ultrasound with preoperative CT images for lumbar spinal fusion surgery[J].International journal of computer assisted radiology and surgery..2019,14(11).1933-1943.

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