C臂机定位在肥胖患者腰椎穿刺困难中的应用

摘要

目的:观察C臂机影像引导定位在肥胖患者腰椎穿刺困难中应用的效果.方法:选择我院ASA I～Ⅱ级需行腰椎椎管内麻醉且传统手法无法定位出腰椎椎间隙的患者60例,随机分为C臂机影像引导定位腰椎穿刺组(A组)和传统常规腰椎穿刺组(B组),每组各30例.A组应用C臂机进行透视定位腰椎间隙,然后按直入法进行腰椎穿刺;B组采用人工手法定位腰椎间隙,然后按直入法进行腰椎穿刺,记录定位时间、腰椎穿刺时间、定位加腰椎穿刺总时间.结果:A组平均定位时间为(4.03±0.65)min,腰椎穿刺时间(皮肤消毒到穿刺针确认成功进入硬膜外腔)为(6.55±1.34)min,定位加腰椎穿刺总时间为(10.58±1.23)min.B组平均定位时间为(0.95±0.24)min,腰椎穿刺时间(皮肤消毒到穿刺针确认成功进入硬膜外腔)为(19.30±8.05)min,定位加腰椎穿刺总时间为(20.25±8.09)min,两组在定位时间、腰椎穿刺时间、定位加腰椎穿刺总时间方面比较,差异有统计学意义(P<0.05).A组30例(100%)腰椎椎管内穿刺全部成功,B组26例(86.7%)腰椎椎管内穿刺成功,4例(13.3%)穿刺失败而用改其他麻醉方式.结论:C臂机影像引导定位肥胖患者腰椎穿刺,具有定位准确,缩短腰椎穿刺时间的优势,并能提高腰椎椎管内穿刺成功率,减少了反复穿刺对患者造成的损伤.%Objective: To observe the application effect of C-arm machine image-guided positioning in lumbar puncture difficulty of obese patients. Methods: 60 cases of patients of ASA I -Ⅱ , who required lumbar vertebrae intravertebral anesthesia and lumbar vertebrae intravertebral space and could not be positioned with conventional methods were selected in our hospital. All patients were randomly divided into C-arm machine image-guided positioning lumbar puncture group (group A) and traditional routine lumbar puncture group (group B), with 30 cases in each group. C-arm machine for perspective positioning of lumbar intervertebral space and then straight entry method for lumbar puncture were used in group A. Artificial method for positioning of lumbar intervertebral space, and then straight entry method for lumbar puncture were used in group B. The positioning time, lumbar puncture time and total time of positioning plus lumbar puncture time were recorded. Results: In group A, the positioning time was (4.03 ±0.65) min, the lumbar puncture time (from skin disinfection tosuccessful entry of the needle into the epidural space) was (6.55 ±1.34) min, and the total time of positioning plus lumbar puncture was (10.58+1.23) min. In group B, the positioning time was (0.95±0.24) min, the lumbar puncture time (from skin disinfection to successful entry of the needle into the epidural space) was (6.55 ±1.34) min, and the total time of positioni ing plus lumbar puncture was (20.25±8.09) min. Compared the positioning time, lumbar puncture time and the total time of positioning plus lumbar puncture of group A with group B, the differences were statistically significant (P<0.05). 30 cases (100%) of group A had successful lumbar intervertebral puncture while 26 cases (86.7%) of group B had successful lumbar intervertebral puncture and 4 cases (13.3%) were used other anesthesia method due to lumbar intervertebral puncture failure. Conclusion: C-arm machine positioning image-guided lumbar puncture is superiority in accurately positioning and shortening lumbar puncture time. It can improve the success rate of lumbar intervertebral puncture and reduce the injury to patients which is caused by repeated lumbar intervertebral puncture.