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投稿时间：2025-02-02 网络发布日期：2025-10-20
投稿时间：2025-02-02 网络发布日期：2025-10-20
中文摘要: 目的 比较三维脊柱超声引导腰硬联合麻醉穿刺术与传统腰硬联合麻醉穿刺术在老年患者中的有效性与安全性。方法 选取2022年4月至2023年12月期间于洪湖市人民医院麻醉科行腰硬联合麻醉的老年患者100例，采用随机数字表法随机分为超声组（U组）和对照组（C组），每组50例。C组采用传统触摸法定位穿刺点，U组使用手持式超声Accuro进行定位。比较两组穿刺成功所需次数、1次穿刺成功率、定位时间、穿刺时间、穿刺方向调整次数、穿刺相关并发症及患者满意度等指标。结果 U组穿刺成功所需次数少于C组（Z=3.851，P <0.01），1次穿刺成功率显著高于C组（94.0% vs 62.0%，χ2=14.918，P <0.01）。与C组比较，U组定位时间和总穿刺时间较长（P <0.01），但完成穿刺时间较短［（9.5（9.4，9.7）min vs 10.4（10.2，11.1）min，Z=8.358，P <0.01］、穿刺方向调整次数较少［2（1，2）vs 2（2，2），Z=2.993，P <0.01］。U组无任何并发症发生，C组有6例发生穿刺及置管异感，C组并发症率高于U组（0 vs 12.0%，χ2=4.433，P<0.05）。两组患者满意度差异无统计学意义（P>0.05）。结论 三维脊柱超声引导腰硬联合麻醉穿刺术可提高老年患者1次穿刺成功率，降低并发症发生率，为其临床应用提供了证据基础。
Abstract:Objective To compare the effectiveness and safety between three - dimensional spinal ultrasound - guided combined spinal-epidural anesthesia（CSEA）and traditional CSEA in elderly patients. Methods A total of 100 elderly patients undergoing CSEA in the Department of Anesthesiology at the People'’s Hospital of Honghu between April 2022and December 2023 were selected and randomly divided into an ultrasound group（group U）and a control group（group C）according to the random number table method，with 50 patients in each group. The C group used the traditional palpation method to locate the puncture point，while the U group utilized the handheld ultrasound device Accuro for localization. Number of attempts required for successful punctures，first attempt success rate，locating time，puncture time，number of puncture direction adjustments，puncture-related complications，and patient satisfaction were compared between the two groups. Results The number of successful punctures in group U was less than that in group C（Z =3.851，P < 0.01），and the first attempt success rate was significantly higher than that in group C（92.0%vs 62.0%，χ2=14.918，P< 0.01）. Compared with group C，the locating time and total puncture time in group U were longer（P <0.01），but the puncture time was shorter［（9.5（9.4，9.7）min vs 10.4（10.2，11.1）min，Z = 8.358，P < 0.01］，and the number of puncture direction adjustments was less［2（1，2）vs 2（2，2），Z=2.993，P <0.01］. No complications occurred in group U，and 6 cases in group C developed paraesthesia through puncture and catheter placement. The complication rate in group C was higher than that in group U（0 vs 12.0% ，χ2=4.433，<0.01<0.05）. There was no significant difference in patient satisfaction between the two groups（P>0.05）. Conclusion Three - dimensional spinal ultrasound -guided CSEA can improve the first attempt success rate，reduce the incidence of complications in elderly patients，providing an evidence basis for the choice of clinical application.
keywords: Three-dimensional spinal ultrasound Combined spinal-epidural anesthesia Intravertebral canal puncture Location Puncture
文章编号： 中图分类号：R614.4 文献标志码：A
基金项目:国家自然科学基金面上项目（82272238）；麻醉复苏教育部重点实验室面上项目（2023MZFS004）
附件
| Author Name | Affiliation |
| LI Weicheng*，WEI Wei，PENG Bishun，CHEN Wu，TAN Minghe，XIA Haifa | *Department of Anesthesiology,The People's Hospital of Honghu / Union Honghu Hospital,Honghu,Hubei 433200,China |
引用文本：
李伟承,魏巍,彭必顺,等.三维脊柱超声引导腰硬联合麻醉穿刺术在老年患者手术中的应用[J].中国临床研究,2025,38(10):1490-1493.
李伟承,魏巍,彭必顺,等.三维脊柱超声引导腰硬联合麻醉穿刺术在老年患者手术中的应用[J].中国临床研究,2025,38(10):1490-1493.