临床小儿外科杂志2024，Vol.23Issue(11)：1035-1041,7.DOI:10.3760/cma.j.cn101785-202406044-007
可视化骶管穿刺技术用于骶尾肥厚患儿的麻醉效果分析
Analysis of the anesthetic effect of visual sacral canal puncture in children with sacrococcygeal hyper-plasia
摘要
Abstract
Objective To investigate the efficacy of a novel visualization technique for caudal epidural catheterization to improve the success rate and efficacy of caudal block in children with sacrococcygeal hypertro-phy.Methods A retrospective analysis was conducted on 196 cases of children with sacrococcygeal hypertro-phy who received caudal block performed by the same anesthesiologist at Shanghai Children's Hospital from July 2016 to January 2024.Based on the different puncture techniques used for the caudal block,the cases were di-vided into three groups:traditional technique group(125 cases),ultrasound-guided group(18 cases),and in-tergluteal cleft positioning group(53 cases).Data collected included age,gender,weight,height,body mass in-dex(BMI),first puncture success rate,completion rate of the caudal block effect,heart rate,and systolic blood pressure at the start of anesthesia and during skin incision.Results Compared to the traditional technique group,both the ultrasound-guided group and the intergluteal cleft positioning group achieved higher first punc-ture success rate(17/18 vs.78/125,42/53 vs.78/125,P＜0.05)and better caudal block effects(16/18 vs.78/125,49/53 vs.78/125,P＜0.05).At the start of anesthesia,the heart rates were(92.3±14.1)beats/min for the traditional technique group,(104.0±11.6)beats/min for the ultrasound-guided group,and(95.4±14.4)beats/min for the gluteal crease positioning group.Systolic blood pressures were(99.9±10.6)mmHg for the traditional technique group,(99±10.6)mmHg for the ultrasound-guided group,and(107.0±11.0)mmHg for the gluteal crease positioning group;all differences in heart rates and systolic blood pressures among the three groups were statistically significant(P＜0.05).During skin incision,heart rates were(92.4±14.1)beats/min for the traditional technique group,(105.0±12.7)beats/min for the ultrasound-guided group,and(95.9±15.2)beats/min for the gluteal crease positioning group.Systolic blood pressures were(101.0±10.6)mmHg for the traditional technique group,(93.9±9.4)mmHg for the ultrasound-guided group,and(104.0±10.8)mmHg for the gluteal crease positioning group;again,differences were statistically significant(P＜0.05).Multivariate logistic regression analysis found that the new visualization techniques(ultrasound-guided caudal block:OR=7.901,95％CI:1.923-54.913;gluteal crease positioning caudal block:OR=11.539,95％CI:3.726-45.950)were independent correlates of effective caudal block(P＜0.05).Height(OR=1.278,95％CI:1.051-1.574),weight(OR=0.705,95％CI:0.535-0.908),BMI(OR=2.273,95％CI:1.182-4.656),and caudal block methods(ultrasound-guided caudal block technique:OR=10.046,95％CI:1.908-185.923;gluteal crease positioning caudal block:OR=3.650,95％CI:1.516-9.890)were factors related to the first puncture success(P＜0.05).Conclusions Compared to traditional techniques,the novel visualization techniques significantly improved the first puncture success rate and effectiveness of caudal block in children with sacrococcygeal hypertrophy.The gluteal crease positioning technique provides a reliable alternative to ultrasound guidance.关键词
骶管阻滞/超声/外科手术/儿童Key words
Caudal Block/Ultrasound/Surgical Procedures,Operative/Child引用本文复制引用
童易如,张号绒,娄曼,魏嵘,Henry Liu..可视化骶管穿刺技术用于骶尾肥厚患儿的麻醉效果分析[J].临床小儿外科杂志,2024,23(11):1035-1041,7.基金项目
上海市儿童医院院级课题(2020YLYZ05) Project of Shanghai Children's Hospital(2020YLYZ05) （2020YLYZ05）
