[1]李宗师 康志宇 尤文阳 卢松波 李哲 张玉娥 赵静芝 韩彬**①.超声辅助定位在老年髋部骨折患者椎管内麻醉中的应用：前瞻性随机对照研究[J].中国微创外科杂志,2025,01(1):1-7.
　Li Zongshi,Kang Zhiyu,You Wenyang,et al.Application of Ultrasoundassisted Localization in Spinal Anesthesia for Elderly Patients With Hip Fractures: a Prospective Randomized Controlled Study[J].Chinese Journal of Minimally Invasive Surgery,2025,01(1):1-7.
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超声辅助定位在老年髋部骨折患者椎管内麻醉中的应用：前瞻性随机对照研究()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2025年1期
页码:
1-7
栏目:
临床论著
出版日期:
2025-01-25

文章信息/Info

Title:
Application of Ultrasoundassisted Localization in Spinal Anesthesia for Elderly Patients With Hip Fractures: a Prospective Randomized Controlled Study
作者:
李宗师 康志宇 尤文阳 卢松波 李哲 张玉娥 赵静芝 韩彬**①
(北京市延庆区医院北京大学第三医院延庆医院麻醉科，北京102100)
Author(s):
Li Zongshi;  Kang Zhiyu;  You Wenyang;  et al.
Department of Anesthesiology, Beijing Yanqing District Hospital, Peking University Third Hospital Yanqing Hospital, Beijing 102100, China
关键词:
超声辅助定位; 老年患者; 髋部骨折; 椎管内麻醉
Keywords:
Ultrasoundassisted localization; Elderly patients; Hip fractures; Spinal anesthesia
文献标志码:
A
摘要:
目的探讨超声辅助定位在老年髋部骨折患者椎管内麻醉中的应用效果。方法选取2022年9月~2024年6月我科椎管内麻醉下髋部骨折手术的老年患者114例，采用随机数字表法分为体表解剖标志定位组和超声辅助定位组，每组57例。2组患者椎管内麻醉操作均采用旁正中入路进行穿刺，比较一次穿刺成功率、首个穿刺点穿刺成功率、皮肤穿刺次数、调整硬膜外针方向次数、穿刺点定位时间、穿刺时间(穿刺成功时间、麻醉操作时间、总时间)、穿刺过程中不良事件(神经异感、意外穿破硬脊膜)、椎管内麻醉相关并发症(腰痛、头痛、神经损伤)、患者满意度和住院时间，术后24 h采用15项恢复质量(15Item Quality of Recovery，QOR15)量表评估患者术后早期恢复质量。结果超声辅助定位组一次穿刺成功率719%(41/57)，明显高于体表解剖标志定位组281%(16/57)(χ2=21930，P=0000)；超声辅助定位组首个穿刺点穿刺成功率877%(50/57)，明显高于体表解剖标志定位组544%(31/57)(χ2=15396，P=0000)。超声辅助定位组皮肤穿刺次数和调整硬膜外针方向次数分别为1(1，1)、0(0，1)次，体表解剖标志定位组分别为2(1，3)、3(0，5)次，2组差异均有显著性(均P=0000)。超声辅助定位组穿刺定位时间22(17，32)min，明显长于体表解剖标志定位组08(05，12)min(Z=-8418，P=0000)。超声辅助定位组穿刺成功时间、麻醉操作时间和总时间分别为19(17，23)、49(43，53)、71(63，87)min，体表解剖标志定位组分别为51(23，80)、79(57，110)、86(66，120)min，2组差异均有显著性(P<005)。2组操作时神经异感发生率(35%vs.70%， χ2=0176，P=0675)、硬膜外针意外穿破硬脊膜发生率(0% vs.35%，P=0496)、术后头痛发生率(0%vs.35%，P=0496)、腰痛发生率(18%vs.105%， χ2=2435，P=0119)差异均无统计学意义。2组患者术后均无神经损伤症状出现，术后24 h QOR15量表评分［119(115，124)分vs.116(112，121)分，Z=-1858，P=0063］、住院时间［100(90，125)d vs.100(80，130)d，Z=-0043，P=0966］差异无统计学意义；超声辅助定位组患者满意度显著高于体表解剖标志定位组(P=0004)。结论超声辅助定位应用于老年髋部骨折患者椎管内麻醉，可以明显提高一次穿刺成功率、首个穿刺点穿刺成功率，减少皮肤穿刺次数和调整硬膜外针方向次数，明显缩短麻醉操作时间，提高患者满意度，值得临床推荐应用。
Abstract:
ObjectiveTo explore the application effect of ultrasoundassisted localization in spinal anesthesia for elderly patients with hip fractures.MethodsA total of 114 elderly patients undergoing hip fracture surgery with spinal anesthesia in our hospital from September 2022 to June 2024 were enrolled. The random number table method was applied to allocate participants into two groups: surface anatomical landmark localization group and ultrasoundassisted localization group, with 57 patients in each group. Both groups of patients underwent spinal anesthesia via the paramedian approach for puncture. The firstattempt puncture success rate, success rate of the initial puncture site, number of skin punctures, number of adjusted epidural needle direction, positioning time of the puncture point, puncture time (puncture success time, anesthesia time, and total time), adverse events during the puncture process (nerve hypersensitivity and accidental puncture of the dura mater), spinal anesthesia related complications (back pain, headache, and nerve injury), patient satisfaction and hospital stay were observed and compared between the two groups. The quality of early postoperative recovery was evaluated by using the 15Item Quality of Recovery (QOR15) scale at 24 h after surgery.ResultsThe firstattempt puncture success rate in the ultrasoundassisted localization group was 71.9%(41/57), which was significantly higher than that in the surface anatomical landmark localization group ［28.1%(16/57), χ2=21.930, P=0.000］. The success rate of the initial puncture site in the ultrasoundassisted localization group was 87.7%(50/57), which was significantly higher than that in the surface anatomical landmark localization group ［54.4%(31/57), χ2=15.396, P=0.000］. The number of skin punctures and adjusted epidural needle direction in the ultrasoundassisted localization group were 1 (1,1) and 0 (0,1) times, while in the surface anatomical landmark localization group were 2 (1,3) and 3 (0,5) times, with statistically significant differences (all P=0.000). The puncture positioning time in the ultrasoundassisted localization group was 2.2 (1.7,3.2) min, which was significantly longer than that in the surface anatomical landmark localization group ［0.8 (0.5,1.2) min, Z=-8.418, P=0.000］. The puncture success time, anesthesia time, and total time of the ultrasoundassisted localization group were 1.9 (1.7,2.3), 4.9 (4.3,5.3), and 7.1 (6.3,8.7) min, while of the surface anatomical landmark localization group were 5.1 (2.3,8.0), 7.9 (5.7,11.0), and 8.6 (6.6,120) min, with statistically significant differences (all P<0.05). There were no statistically significant differences in the incidence of nerve hypersensitivity during operation (3.5%vs.7.0%, χ2=0.176,P=0.675), accidental puncture of the dura mater by epidural needles (0 vs.3.5%, P=0.496), postoperative headache (0 vs.3.5%, P=0.496), and back pain (1.8%vs.10.5%, χ2=2.435,P=0.119) between the two groups. Both groups of patients showed no symptoms of nerve injury after surgery. There were no statistically significant differences in QOR15 scores at 24 h postoperatively ［119 (115,124) points vs.116 (112,121) points, Z=-1.858, P=0.063］ and length of hospital stay ［10.0 (9.0,12.5) d vs. 10.0 (8.0,13.0) d, Z=-0.043, P=0.966］ between the two groups. The satisfaction of patients in the ultrasoundassisted localization group was significantly higher than that in the surface anatomical landmark localization group (P=0.004).ConclusionApplication of ultrasoundguided localization in spinal anesthesia for elderly patients with hip fractures significantly improves the firstattempt puncture and initial puncture site success rates, reduces skin puncture attempts and adjustments of the epidural needle direction, shortens time of anesthetic procedure, and enhances patient satisfaction, making it highly recommendable for clinical use.

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备注/Memo

备注/Memo:
基金项目：北京市科协金桥工程种子资金资助项目（ZZ22051）**通讯作者，Email：13601076527@163.com ①（北京大学第三医院麻醉科，北京100191）
更新日期/Last Update: 2025-03-28