超声辅助定位椎管内麻醉技术在老年患者外科手术中的应用

Application of Ultrasound-Assisted Localization for Neuraxial Anesthesia in Elderly Patients Undergoing Surgery

摘要: 目的：分析超声辅助定位椎管内麻醉技术在老年外科手术患者中的应用价值，对比其与传统体表解剖定位法的临床效果、穿刺相关指标、并发症及患者满意度，为老年人群椎管内麻醉的临床规范化应用提供参考依据。方法：采用前瞻性随机对照研究，纳入2024年12月~2026年3月于我院接受椎管内麻醉手术的老年患者66例，按照随机数字表法分为超声辅助组(A组，33例)与传统解剖定位组(B组，33例)。A组采用低频凸阵探头行超声扫查定位椎间隙并标记后实施腰硬联合麻醉，B组依靠传统体表解剖标志定位完成穿刺操作。比较两组穿刺定位时间、总穿刺次数、穿刺成功时间、首次穿刺成功率、首个穿刺点成功率等核心穿刺指标；统计神经异感、硬膜外意外穿破、术后头痛、腰痛、肢体麻木等麻醉相关并发症发生情况；采用等级评分评价并对比两组患者麻醉满意度。结果：A组穿刺定位时间、总穿刺次数、穿刺成功时间均显著低于B组，差异具有统计学意义(P < 0.001)；A组首次穿刺成功率、首个穿刺点成功率显著高于B组(P < 0.001)。两组各类穿刺相关并发症发生率对比无明显差异(P > 0.05)。患者满意度结果显示，A组满意度整体优于B组，组间差异有统计学意义(P = 0.019)。结论：针对存在脊柱退行性改变、体表标志不清等解剖特点的老年手术患者，超声辅助定位椎管内麻醉可实现可视化精准定位，有效缩短麻醉操作时长、减少反复穿刺次数、大幅提升穿刺成功率，且不会增加麻醉相关并发症，同时能够减轻患者痛苦、提升就医体验，操作简便、安全性高，适合在老年患者麻醉中广泛推广使用。

Abstract: Objective: To analyze the clinical application value of ultrasound-assisted localization for neuraxial anesthesia in elderly patients undergoing surgical procedures, and compare its clinical efficacy, puncture-related indicators, complications and patient satisfaction with the traditional surface anatomical localization method, so as to provide a reference for the standardized clinical application of neuraxial anesthesia in the elderly population. Methods: A prospective randomized controlled trial was conducted. A total of 66 elderly patients who received surgery under neuraxial anesthesia in our hospital from December 2024 to March 2026 were enrolled and divided into the ultrasound-assisted group (Group A, 33 cases) and the traditional anatomical localization group (Group B, 33 cases) by random number table. In Group A, a low-frequency convex array probe was used for ultrasound scanning to locate and mark the vertebral interspace before combined spinal-epidural anesthesia was performed. In Group B, puncture was completed relying on traditional surface anatomical landmarks. The core puncture indicators including localization time, total puncture attempts, successful puncture time, one-time success rate of puncture and success rate of the initial puncture site were compared between the two groups. The incidence of anesthesia-related complications such as paresthesia, accidental dural puncture, postoperative headache, lumbago and limb numbness was recorded. Patient satisfaction with anesthesia was evaluated by graded scoring and compared between the two groups. Results: The localization time, total puncture attempts and successful puncture time in Group A were significantly lower than those in Group B, with statistically significant differences (P < 0.001). The one-time success rate of puncture and success rate of the initial puncture site in Group A were markedly higher than those in Group B (P < 0.001). No significant difference was found in the incidence of various puncture-related complications between the two groups (P > 0.05). The overall patient satisfaction in Group A was superior to that in Group B, and the difference was statistically significant (P = 0.019). Conclusion: For elderly surgical patients complicated with spinal degenerative changes and unclear surface anatomical landmarks, ultrasound-assisted localization for neuraxial anesthesia realizes visualized and precise positioning. It can effectively shorten the operation duration, reduce repeated puncture attempts and greatly improve the puncture success rate, without increasing the risk of anesthesia-related complications. Meanwhile, it alleviates patients’ discomfort and improves medical experience. With simple operation and high safety, this technique is worthy of wide clinical promotion in anesthesia for elderly patients.