CT联合超声引导骨科手术腰椎硬膜外麻醉分析

CT联合超声引导骨科手术腰椎硬膜外麻醉分析

吴静,罗晓刚

湖北中医药大学黄家湖医院麻醉科,武汉工程大学化工与制药学院

收稿日期:2017-08-28 修回日期:2017-08-28 出版日期:2017-09-25
基金资助:
国家自然科学基金（项目编号：51303142；项目名称：再生纤维素微球的可控制备及结构和性能关系研究）

Analysis of CT Combined with Ultrasound Guided Lumbar Epidural Anesthesia in Orthopedics Surgery

吴静 and luoxiaogang

Department of Anesthesiology, Huangjiahu Hospital, Hubei University of Traditional Chinese Medicine,School of Chemical Engineering and Pharmaceutical Engineering, Wuhan University of Engineering

Received:2017-08-28 Revised:2017-08-28 Online:2017-09-25

摘要/Abstract

摘要： 目的：探讨计算机断层扫描（CT）联合超声引导骨科手术腰椎硬膜外麻醉的可行性和经济效益。方法：将拟行骨科手术治疗患者60例按数字随机法分为研究组（n=30）和对照组（n=30）。对照组行超声引导腰椎硬膜外麻醉和手术治疗，研究组在CT和超声引导下行腰椎硬膜外麻醉和手术治疗。比较两组麻醉有效率（效益，E研究组、E对照组）、麻醉准备时间、穿刺时间、1次穿刺成功率、起效时间及麻醉相关费用（成本、C研究组、C对照组）等，并计算比较两组成本效益比（R）（R研究组=C研究组/E研究组、R对照组=C对照组/E对照组）以及研究组相对对照组增加的成本-增加的效果比[ΔR=（C研究组- C对照组）/（E研究组- E对照组）]。结果：研究组麻醉有效率为93.33%，高于对照组的63.33%（P＜0.05）。与对照组比较，研究组麻醉准备时间和穿刺时间缩短、1次穿刺成功率和麻醉相关费用提高，差异有统计学意义（P＜0.05）。两组起效时间和并发症发生率比较差异无统计学意义（P＞0.05）。R研究组为9.99，R对照组为11.76，ΔR为6.26，CT联合超声引导骨科手术腰椎硬膜外麻醉的经济效益良好。结论：CT联合超声引导骨科手术腰椎硬膜外麻醉是骨科手术腰椎硬膜外麻醉的经济、安全有效方案。

Abstract: Objective：To investigate the feasibility and economic benefit of computed tomography（CT）combined with ultrasound guided lumbar epidural anesthesia in orthopedics surgery. Methods：60 cases of patients who were treated with orthopedics were divided into study group（n=30） and control group（n=30）randomly. The control group was treated with ultrasound guided lumbar epidural anesthesia and surgical treatment， and the study group was treated with CT and ultrasound guided lumbar epidural anesthesia and surgical treatment. Anesthesia efficiency (efficiency， Estudy group， Econtrol group)， anesthesia preparation time， puncture time， oncepuncture success rate， anesthesia onset time， and anesthesia related costs (cost， Cstudy group， Ccontrol group) of two groups were compared. The benefit cost ratio(R) (Rstudy group=Cstudy group/Estudy group， Rcontrol group=Ccontrol group/Econtrol group) of two groups were calculated and compared. Increased cost and increased effect of the study group relative to the control group [ΔR=(Cstudy group-Ccontrol group)/(Estudy group-Econtrol group)] was also calculated.Results：The anesthesia effective rate of the study group was 93.33%， which was higher than 63.33% of the control group (P＜0.05). Compared with the control group， the anesthesia preparation time and puncture time of the study group were shorter， and the once puncture success rate and anesthesia related costs of the study group were increased (P＜0.05). There was no significant difference in the anesthesia onset time and complication rate in the two groups (P＞0.05). Rstudy group was 9.99， R control group was 11.76， ΔR was 6.26， the economic benefits of CT combined with ultrasound guided lumbar epidural anesthesia in orthopedics surgery was excellent. Conclusion：CT combined with ultrasound guided lumbar epidural anesthesia in orthopedics surgery is an economical， safe and effective method for lumbar epidural anesthesia in orthopedics operation.

吴静,罗晓刚. CT联合超声引导骨科手术腰椎硬膜外麻醉分析[J]. .

吴静 and luoxiaogang. Analysis of CT Combined with Ultrasound Guided Lumbar Epidural Anesthesia in Orthopedics Surgery[J]. .

参考文献

[1]王宇,朱云章,刘刚,等.高龄患者髋、膝关节置换中罗哌卡因腰椎硬膜外麻醉的镇痛效果[J].中国组织工程研究,2015,19(13):1990-1994.
[2]王鹭蓉,陈振毅.腰麻-硬膜外麻醉在超高龄患者骨折手术中的价值分析[J].中外医疗,2015,34(27):11-12,19.
[3]Seitel A, Sojoudi S, Osborn J,et al.Ultrasound-Guided Spine Anesthesia: Feasibility Study of a Guidance System[J].Ultrasound Med Biol,2016,42(12):3043-3049.
[4]何明伟,葛维鹏,马骏,等.CT引导下连续硬膜外腔阻滞联合低温等离子射频治疗腰椎间盘突出症效果分析[J].中国医药,2015,10(4):539-542.
[5] 李亚威,田跃.成人股骨干骨折两种治疗方式的卫生经济学评价[J].医学研究与教育,2016,33(4):11-16.
[6]王建生.超声引导下腰丛-坐骨神经联合阻滞和连续硬膜外麻醉在膝关节镜手术中的麻醉效果比较[J].生物骨科材料与临床研究,2016,13(4):22-24.
[7]王振昊,王书诚,王珂,等.硬膜外麻醉闭合穿针加距形外固定治疗架治疗股骨颈骨折临床分析[J].中国实用神经疾病杂志,2012,15(6):82.
[8]张付化.腰麻联合硬膜外麻醉在老年股骨颈骨折患者手术中的应用[J].河南医学研究,2016,25(4):735-736.
[9]张勇.腰麻-硬膜外麻醉在老年患者股骨颈骨折手术中的应用观察[J].川北医学院学报,2016,31(4):589-592.
[10]Behnami D, Seitel A, Rasoulian A,et al.Joint registration of ultrasound, CT and a shape+pose statistical model of the lumbar spine for guiding anesthesia[J].Int J Comput Assist Radiol Surg,2016,11(6):937-945.
[11]詹劲松,黄光胜,许汉雄,等.腰椎间盘CT检查在腰椎椎管内麻醉操作中的价值[J].中国现代医生,2007,45(20):107-108.
[12]陈磊,张兆波,宗蓓蓓,等.人工膝关节置换术早期康复的卫生经济学评价[J].中国康复,2016,31(1):48-50.
[13] 侯爱云.超激光疼痛治疗仪照射治疗椎管内麻醉后腰背痛的临床观察[J].中国医药导刊,2010,12(9):1496-1497.
[14] Albert van Schoor,M.C. Bosman,A.T. Bosenberg et al.The value of Tuffier's line for neonatal neuraxial procedures[J].Clinical anatomy: official journal of the American Association of Clinical Anatomists amp; the British Association of Clinical Anatomists,2014,27(4):370-375.
[15] Albert van Schoor,M.C. Bosman,A.T. Bosenberg et al.The value of Tuffier's line for neonatal neuraxial procedures[J].Clinical anatomy: official journal of the American Association of Clinical Anatomists amp; the British Association of Clinical Anatomists,2014,27(3):370-375.
[16] Kamra,K.,Mills,R.,Hammer,G. et al.Epidural blood patch relieves positional diplopia following lumbar punctures[J].Paediatric anaesthesia,2014,24(3):345-347.
[17] Carregaro, Adriano B.,Freitas, Gabrielle C.,Lopes, Carlize et al.Evaluation of analgesic and physiologic effects of epidural morphine administered at a thoracic or lumbar level in dogs undergoing thoracotomy[J].Veterinary Anaesthesia and Analgesia,2014,41(2):205-211.
[18] Akakin, Akin,Yilmaz, Baran,Akay, Alp et al.Epidural Anesthesia in Elective Lumbar Microdiscectomy Surgery: Is It Safe and Effective?[J].Turkish neurosurgery,2015,25(1):117-120.
[19] Stephen Choi,Y Raja Rampersaud,Vincent W S Chan et al.The addition of epidural local anesthetic to systemic multimodal analgesia following lumbar spinal fusion: a randomized controlled trial.[J].Canadian journal of anesthesia: Journal canadien d'anesthesie,2014,61(4):330-339.
[20] Jonathan J Gamble,Barbara Ambros,Patrick Séguin et al.Stimulating thoracic epidural placement via a lumbar approach causes significant spinal cord damage in a porcine model.[J].Canadian journal of anesthesia: Journal canadien d'anesthesie,2014,61(4):306-311.

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