蓝英年 韦惠 黄霄 周飞人 谭新梅

[摘要] 目的 探讨超声引导在肥胖患者腰椎穿刺中的临床价值。 方法 选取我院2014年6月～2016年6月收治拟行腰椎穿刺肥胖患者82例，根据随机数字表法随机分为观察组（41例）与对照组（41例），对照组采取盲探穿刺，观察组于超声引导下行硬膜外穿刺。比较两组穿刺时间、穿刺次数。计算和比较两组穿刺成功率。比较两组术后并发症头痛、腰痛发生率。 结果 观察组患者的穿刺时间、穿刺次数明显少于对照组（P<0.05）。观察组穿刺成功率显著高于对照组（P<0.05）。观察组腰痛发生率显著低于对照组（P<0.05）；两组头痛发生率比较差异无统计学意义（P>0.05）。 结论 与传统穿刺术比较，超声引导下肥胖患者腰椎穿刺所需时间少，穿刺成功率高，且術后患者腰痛发生率低，值得在临床推广应用。

[关键词] 超声引导；肥胖；腰椎穿刺；硬膜外麻醉

[中图分类号] R614 [文献标识码] B [文章编号] 1673-9701（2018）10-0121-03

The value of ultrasound guidance in lumbar puncture of obese patients

LAN Yingnian WEI Hui HUANG Xiao ZHOU Feiren TAN Xinmei

Department of Anesthesiology， the People's Hospital of Hechi City in Guangxi Zhuang Autonomous Region， Hechi 547000， China

[Abstract] Objective To investigate the clinical value of ultrasound guidance in lumbar puncture of obese patients. Methods 82 obese patients with lumbar puncture who were scheduled for lumbar puncture admitted in our hospital from June 2014 to June 2016 were selected and randomly divided into observation group （n=41） and control group （n=41）， according to random number table method. The control group underwent blind exploration puncture， and the observation group was treated with ultrasound guided epidural puncture. The puncture time and puncture frequency between the two groups were compared. The puncture success rate between the two groups was calculated and compared. The incidence of postoperative headache and back pain was compared between the two groups. Results The puncture time and puncture frequency of the two groups in the observation group was significantly less than that of the control group （P<0.05）. The success rate of puncture in observation group was significantly higher than that in control group（P<0.05）. The incidence of back pain in the observation group was significantly lower than that in the control group（P<0.05）. There was no significant difference in the incidence of headache between the observation group and the control group（P>0.05）. Conclusion Compared with traditional puncture， ultrasound guided lumbar puncture in obese patients need less time and has high puncture success rate， with postoperative low incidence of back pain， and is worthy of clinical application.

[Key words] Ultrasound guidance； Obesity； Lumbar puncture； Epidural anesthesia

硬膜外麻醉和（或）腰硬联合麻醉常需要进行腰椎穿刺，该穿刺技术的成败主要取决于腰椎穿刺点的正确定位、穿刺针的方向[1]。目前临床上腰椎穿刺点的定位主要采用解剖体表标志、触摸棘突间隙、穿刺针盲探等方法。由于肥胖患者皮下脂肪层增厚，韧带、骨性标志不清楚，加之皮肤不易固定，传统腰椎穿刺法存在一定难度[2]。随着人们生活和经济水平的提高，摄入高热量、高脂肪食物超标，或进食热量超过消耗热量，体内脂肪堆积过多，肥胖人群越来越多[3]。据报道当前全球体重超重者达13亿，我国约有7 000万肥胖患者，且有上升趋势[4]。提高肥胖患者的腰椎穿刺术成功率成为当前临床面临的重要医学问题。超声引导下的穿刺在临床得到广泛应用，从淋巴结、甲状腺乳腺等小组织病变到腹腔内巨大病变组织，超声引导下可准确定位穿刺部位，提高病变组织的阳性检出率和诊断的准确性。……