国际麻醉学与复苏杂志   2019, Issue (10): 0-0
    
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
郭敏, 王云, 王雷, 马丹旭1()
1.北京市海淀区妇幼保健院麻醉科
Modified ultrasound-guided epidural anesthesia for patients with spine malformation (one case report)
 全文:
摘要:

椎管内麻醉保留自主呼吸,对心肺功能影响小,是股骨颈骨折患者的首选麻醉方式。但脊柱结构异常的患者,往往穿刺困难,脊髓、神经损伤风险大。超声实时引导下硬膜外穿刺可提高穿刺精准性和有效性,避免神经损伤并发症,对脊柱结构异常的困难穿刺有重大意义。报道1例在脊柱旁正中短轴斜扫描超声实时引导下采用平面内技术,对脊柱结构异常的老年患者行硬膜外穿刺,观察进针深度、方向、毗邻结构及药液扩散情况。介绍脊柱旁正中短轴斜扫描超声实时引导下硬膜外穿刺方法并与长轴法作比较,发现其较长轴法操作更简便,对患者体位无特殊要求,用于脊柱结构异常患者安全、有效,是长轴法的改良。

关键词: 超声引导; 硬膜外穿刺; 脊柱; 畸形; 旁正中短轴斜扫描
Abstract:

Spinal anesthesia keeps the patient′s autonomous respiration, has less influence on cardio-pulmonary function and is suitable for elder people with femoral neck fracture. But it is very difficult and dangerous to complete the epidural anesthesia for patients with spine malformation. In this study, this article described a novel ultrasound-guided technique for epidural access through a para-median transverse scan at the level of articular process, and compared it with the ultrasound-guided long axis scan. Following the in-plane technique under para-median transverse US scanning, this article completed the epidural anesthesia for a patient with spine malformation. This article observed the depth and angle of the spinal needle, the target structure and the structure of adjacent tissue, the diffusion of drugs. The pictures were recorded and stored. Compared with the sagittal scan, the oblique scan is easier to handle. Ultrasound-guided erector spinae plane block is a safe and effective method for spine malformation patients.

Key words: Ultrasound-guided; Epidural access; Spine; Malformation; Para-median transverse US scanning