【作者】 杨帆；

【导师】 仇金鹏；

【作者基本信息】 吉林大学 ， 临床医学硕士（麻醉学）（专业学位）， 2021， 硕士

【摘要】 研究目的:本研究旨在探讨超声预测产妇硬膜外腔穿刺深度的可行性,研究超声测量产妇皮肤至硬膜外腔的深度（Ultrasound-measured depth,UD）和实际穿刺深度（Actual needle insertion depth,ND）二者之间的相关性,以及二者与年龄、身高、体重、BMI（Body mass index）一般身体指标的相关性,以便为后续临床研究提供参考。研究方法:本研究选取在吉林大学第一医院二部行剖宫产术患者60例（2020年8月-2021年2月）,均为中国黄种人,ASA（American society of Anesthesiology）I-II级,年龄20-45岁。排除存在脊柱严重畸形、脊柱疾病、既往腰背部手术史、穿刺部位感染等患者。患者入室后进行一般身体指标采集,包括年龄、身高、体重、BMI。术前使用超声测量患者L_3-4间隙皮肤至后位复合体的距离（UD）,以上数据采集均由同一名麻醉医生完成。数据采集完成后,由另一位不参与数据采集及分析的,且具有3年及以上临床麻醉经验的医生于L_3-4间隙进行麻醉穿刺操作。采用空气阻力法识别硬膜外间隙,确定穿刺针到达硬膜外间隙后,使用无菌钢尺测量皮肤至硬膜外穿刺针针尾的距离,并计算ND。采用Pearson相关系数分析UD与ND的相关性,及二者与年龄、身高、体重、BMI的相关性,运用Bland-Altman分析来检验二者的一致性,采用多元逐步线性回归分析ND与一般身体指标的关系。研究结果:参与本研究的产妇共计60例,其中4例患者在穿刺过程中由正中垂直入路改为旁正中入路,2例更改穿刺间隙,最终纳入患者人数54例。结果表明,（1）UD小于ND（5.16±0.41cm vs 5.62±0.54cm,P<0.05）,差异具有统计学意义;Pearson相关分析示二者间有正相关关系[r=0.944,P<0.05（95%CI:0.902-0.967）];直线回归方程为ND=-0.805+1.246*UD;95%的一致性界限为0.06-0.87。（2）Pearson相关性分析显示:UD和ND与产妇体重、身高、BMI正相关,UD与产妇体重、身高、BMI的相关系数分别为0.852,0.734,0.761,差异具有统计学意义（P<0.05）;ND与产妇体重、身高、BMI的相关系数分别为0.815,0.700,0.736,差异具有统计学意义（P<0.05）。（3）以年龄、身高、体重、BMI为自变量,以ND为因变量,行多元逐步回归分析,结果显示除体重外其余变量与ND均无明显线性关系（P>0.05）。体重与ND间存在正相关关系,相关系数r=0.815,回归方程:ND=2.229+0.044*体重（r²=0.664,r=0.815）。结论:超声测量下皮肤至硬膜外腔深度（UD）与实际穿刺深度（ND）具有正相关关系;UD和ND与产妇体重、身高、BMI有正相关关系;实际硬膜外腔穿刺深度与体重存在线性关系,呈正相关;使用超声测量硬膜外间隙的深度,可以提前为操作者预测进针深度。更多还原

【Abstract】 Objective:The purpose of this study was to explore the feasibility of predicting epidural space depth measured by ultrasound,and to study the correlation between ultrasound-measured depth(UD)and actual needle insertion depth(ND),investigate whether any correlations exist between these distances and age,body weight,height,body mass index(BMI)so as to provide reference for follow-up clinical research.Methods:Sixty patients aged 20-45 years old,ASA I-II,scheduled for cesarean section were enrolled in the second department of the first hospital of Jilin University(August 2020-March 2021).They were all Chinese people.Exclusion criteria were:spinal deformities,spinal diseases,previous surgery to the lumbar region,and infection of puncture site.The general data were collected,including age,height,weight and BMI,the distance from the skin to the posterior complex(UD)in the L3-4 intervertebral space was measured by ultrasound before operation.All data were obtained by the same anesthesiologist.Then,all procedures were performed by another anesthesiologist with more than 3 years of experience in obstetric anesthesia and did not participate in data acquisition and analysis.The L3-4 intervertebral space was the level selected for the puncture.The epidural space detection was performed by eliciting the loss of resistance to air technique.After the puncture needle reached the epidural space,the distance from the skin to the end of the epidural needle was measured by a sterile steel ruler and ND was recorded.The correlation between UD and ND was analyzed by Pearson correlation coefficient,and the consistency between ND and UD was tested by Bland-Altman analysis.The relationships between ND and general physical indicators were analyzed by multiple stepwise linear regression.Results:A total of 60 parturients participated in this study.Of these,4 patients were excluded because of changing puncture path from transverse median approach to paracentesis approach,2 cases changed the puncture space,and finally 54 patients were included.(1)UD and ND were respectively 5.16±0.41 cm and 5.62±0.54 cm,UN was lesser than ND,and the difference was statistically significant(P<0.05).Pearson correlation analysis suggested that there was a positive correlation between them[r=0.944,P<0.05(95%CI:0.902-0.967].The linear regression equation was ND=-0.805+1.246*UD;and the 95%consistency limit was0.06-0.87.(2)Pearson correlation analysis showed that UD and ND were positively correlated with weight,height and BMI.The correlation coefficients between UD and weight,height and BMI were 0.852,0.734 and 0.761 respectively,and the difference were statistically significant(P<0.05).The correlation coefficients between ND and weight,height and BMI were 0.815,0.700 and0.736 respectively,and the difference was statistically significant(P<0.05).(3)Multiple stepwise regression analysis was carried out with age,height,weight and BMI as independent variables and ND as dependent variable.The results showed that there was no obvious linear relationship between ND and other variables except weight.There was a positive correlation between weight and ND.The correlation coefficient was 0.815,and the regression equation was ND=2.229+0.044*weight(r~2=0.664,r=0.815).Conclusion:There was a positive correlation between ultrasound-measured depth(UD)and actual needle insertion depth(ND).UD and ND were positively correlated with weight,height and BMI.There was a linear and positive correlation between ND and body weight.The needle insertion depth could be predicted in advance by using ultrasound to measure the depth of epidural space.更多还原