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題 名 | Spinal Process Landmark as a Predicting Factor for Difficult Epidural Block: A Prospective Study in Taiwanese Patients=以脊椎骨突起分級預期困難實施硬膜外阻斷術--臺灣地區病人之預測性研究 |
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作 者 | 錢懿; 盧奕丞; 王富元; 蘇理盈; 余廣亮; 湯兆舜; | 書刊名 | The Kaohsiung Journal of Medical Sciences |
卷 期 | 19:11 2003.11[民92.11] |
頁 次 | 頁563-568 |
分類號 | 416.5 |
關鍵詞 | 硬膜外麻醉; 脊髓麻醉; 困難硬膜外阻斷術; 脊椎骨突; Epidural anesthesia; Spinal anesthesia; Difficult epidural block; Spinal process; |
語 文 | 英文(English) |
中文摘要 | 雖然硬膜外阻斷術是一種常用的區域麻醉,但在實施上卻經常遭遇到困難。因此我們選取 848 位接受硬膜外阻斷術的患者來評估,以脊椎骨突起分級預期困難實施硬膜外阻斷術之可行性。我們於患者接受硬膜外阻斷術前,收集以下資料:人口學資料、體型 (正常、細瘦、肥胖、懷孕)、脊椎骨解剖構造正常與否、阻斷術部位是腰椎或胸椎、與脊椎骨突起分級(第一級:脊椎骨突起清楚可見、第二級:脊椎骨突起不可見,但可輕易摸出、第三級:脊椎骨突起不可見,摸不出,但突起間隙可摸出、第四級:不屬於前三級)。我們執行所有的硬膜外阻斷術均以標準程序,包括正中法穿刺、18 號 Touhy 針、患者採側臥姿勢。我們以三種方式來評估硬膜外阻斷術的困難度;我們記錄第一次成功率與嘗試次數,嘗試次數則包括皮膚穿刺孔數及改變韌帶穿刺方向次數,依此結果做為評估硬膜外阻斷術困難度的指標。在所有檢驗的因子中,脊椎骨突起分級與三種評估硬膜外阻斷術方式的相關性最佳。脊椎骨變型與體型則和嘗試次數有統計上的相關性。三種評估硬膜外阻斷術方式均顯示胸椎硬膜外阻斷比腰椎困難。我們的結論認為以脊椎骨突起分成 4 級可運用於預期困難硬膜外阻斷術,並可成為麻醉醫師間溝通指標。 |
英文摘要 | Although epidural anesthesia is a common practice in neuraxial blockade, difficult access to the epidural space is a frequent problem in operating theaters. We designed this study of epidural blocks to determine if the spinal landmark grading system is valuable in predicting a difficult epidural block. Before the epidural block, we collected the following data: demographics, body habitus (normal, thin, obese, pregnant), spinal anatomy (normal, deformed), spinal level (lumbar, thoracic), and spinal landmark grade (grade 1: spinous processes visible; grade 2: spinous processes not seen but easily palpated; grade 3: spinous processes not seen and not palpated but the interval between them is palpated as a low landmark under the thumb; grade 4: other). We performed all 848 epidural blocks initially using a midline approach and an 18-gauge Touhy needle. We evaluated the technical difficulty of the epidural block using three methods: whether the epidural block was accomplished at the spinal level (first-level success); the total number of attempts at skin puncture (attempts-S); and total number of attempts to change ligament puncture direction (attempts-L) required to complete the epidural block. Of all examined factors, spinal landmark grade correlated best with technical difficulty as measured by all three methods. Deformed spinal anatomy and body habitus both correlated with difficulty, merely from the total numbers of attempts (attempts-S and attempts-L). Thoracic epidurals were more difficult than lumbar epidurals by all three measures of difficulty. We concluded that this spinal landmark grading system is valuable in predicting a difficult epidural block and advocate its use as a predictor by anesthesiologists. |
本系統中英文摘要資訊取自各篇刊載內容。