目的:硬膜外导管在皮肤下迁移的原因以前没有研究过。我们假设更多的皮下脂肪厚度可能与皮肤下的导管迁移增加有关。
方法:我们对全麻联合硬膜外麻醉的患者进行了回顾性横断面研究,选择在术后前5天内接受胸部和腹部CT扫描的个体。针深度定义为当麻醉师确定针尖已经到达硬膜外腔时从针尖到皮肤表面的距离。我们测量了硬膜外导管从皮肤表面到硬膜外腔的长度(导管长度),和使用CT成像的皮下脂肪厚度(脂肪厚度)。通过从导管长度中减去针头深度来计算迁移距离。
结果:我们分析了127例患者(72例男性),所有患者均通过旁正中入路在左侧卧位插入硬膜外导管。患者的中位年龄为71岁。术后发现硬膜外导管在皮肤下明显弯曲。回归分析显示脂肪厚度对导管长度无显著影响(回归系数0.10,95%置信区间[CI]:-0.17,0.38)。然而,表明脂肪厚度与针头深度呈正相关(回归系数0.50,95%CI:0.30,0.70),脂肪厚度与迁移距离呈负相关(回归系数-0.40,95%CI:-0.65,-0.14)。
结论:我们发现硬膜外导管皮下迁移与皮下脂肪厚度呈负相关。麻醉师应该意识到导管皮下弯曲的可能性,尤其是皮下脂肪不足的患者。
OBJECTIVE: The causes of epidural catheter migration beneath the skin have not been previously investigated. We hypothesized that greater subcutaneous fat thickness might be associated with increased catheter migration beneath the skin.
METHODS: We conducted a retrospective cross-sectional study of patients who had undergone combined general and epidural anesthesia, selecting individuals who received thoracic and abdominal CT scans within the first 5 postoperative days. Needle depth was defined as the distance from the needle tip to the skin surface when the anesthesiologist determined that the needle tip had reached the epidural space. We measured the length of the epidural catheter from the skin surface to the epidural space (catheter length), and subcutaneous fat thickness (fat thickness) using CT imaging. Migration distance was calculated by subtracting needle depth from catheter length.
RESULTS: We analyzed 127 patients (72 males), all undergoing epidural catheter insertion in the left lateral decubitus position via a paramedian approach. The median age of the patients was 71 years. Epidural catheters were postoperatively found to substantially curve beneath the skin. Regression analysis revealed no significant influence of fat thickness on catheter length (regression coefficient 0.10, 95% confidence interval [CI]: - 0.17, 0.38). However, it indicated a positive correlation between fat thickness and needle depth (regression coefficient 0.50, 95% CI: 0.30, 0.70), and a negative correlation between fat thickness and migration distance (regression coefficient - 0.40, 95% CI: - 0.65, - 0.14).
CONCLUSIONS: We found a negative correlation between epidural catheter migration beneath the skin and subcutaneous fat thickness. Anesthesiologists should be aware of the possibility of substantial subcutaneous curving of the catheter, especially in patients with scant subcutaneous fat.