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| 术前超声可视腰椎复合体数量对剖宫产产妇脊髓麻醉困难的预测价值 |
| Predictive value of preoperative ultrasound-visible lumbar vertebral complex quantity for difficult spinal anesthesia in parturients undergoing cesarean section |
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| DOI：10.12089/jca.2025.10.009 |
| 中文关键词: 剖宫产 脊髓麻醉 超声 腰椎复合体 预测 脊髓麻醉困难 |
| 英文关键词: Cesarean section Spinal anesthesia Ultrasound Lumbar vertebral complex Prediction Difficult spinal anesthesia |
| 基金项目:南京市卫生科技发展专项资金项目（YKK22148） |
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| 中文摘要: |
目的：评价术前超声可视腰椎复合体数量对剖宫产产妇脊髓麻醉困难（DSA）的预测价值。
方法：选择2023年7—12月择期在脊髓麻醉下行剖宫产的产妇195例，年龄≥20岁，BMI＞18.5 kg/m2，ASA Ⅰ—Ⅲ级。根据是否发生DSA将产妇分为两组：DSA组（n=54）和非DSA组（n=141）。脊髓麻醉前，采用超声扫描识别产妇腰椎前、后复合体结构，并记录腰椎前、后复合体的可视化情况。记录产妇年龄、体重、BMI、孕期、腹围、宫高、C7到尾骨尖端的距离和脊柱触诊评分。采用单因素和多因素Logistic回归分析筛选DSA的危险因素。绘制受试者工作特征（ROC）曲线，并通过曲线下面积（AUC）评估相关危险因素预测DSA的效能。
结果：与非DSA组比较，DSA组体重明显偏重，BMI明显偏大，腹围明显偏大，C7到尾骨尖端的距离明显偏短，超声可视腰椎复合体数量明显偏多，脊柱触诊评分明显偏低（P<0.05）。单因素Logistic回归分析结果显示，体重、BMI、腹围、C7到尾骨尖端的距离、超声可视腰椎复合体数量、脊柱触诊评分与DSA的发生相关（P<0.05）。多因素Logistic回归分析结果显示，超声可视腰椎复合体数量≤1个为发生DSA的独立危险因素。超声可视腰椎复合体数量预测DSA的ROC曲线AUC为0.900（95%CI 0.839～0.961），敏感性为0.833，特异性为0.943。内部验证模型ROC曲线的AUC为0.899（95%CI 0.841 ～0.949，Z=14.525，P＜0.001），提示区分度良好。
结论：超声可视腰椎复合体数量≤1个可有效预测剖宫产产妇DSA的发生，且该指标具有较高的预测效能。 |
| 英文摘要: |
Objective: To evaluate the predictive value of preoperative ultrasound-visible lumbar vertebral complex quantity for difficult spinal anesthesia (DSA) in parturients undergoing cesarean section.
Methods: A total of 195 parturients undergoing elective cesarean section under spinal anesthesia from July to December 2023 were selected, aged ≥ 20 years, BMI > 18.5 kg/m2, ASA physical status Ⅰ-Ⅲ. The parturients were divided into two groups based on whether DSA occurred: the DSA group (n = 54) and the non-DSA group (n = 141). Ultrasound scanning was used before spinal anesthesia to identify the anterior and posterior lumbar complex structures of the parturient, and the visualization of the anterior and posterior lumbar complexes was recorded. The age, weight, BMI, gestational age, abdominal circumference, uterine height, distance from C7 to the coccyx tip, and spinal palpation score were recoeded. Univariate and multivariate logistic regression analyses were performed to screen for risk factors of DSA. The receiver operating characteristic (ROC) curve was plotted, and and the efficacy of related risk factors in predicting DSA was evaluated by the area under the curve (AUC).
Results: Gompared with the non-DSA group, the weight in the DSA group was significantly heavier, the BMI in the DSA group was significantly higher, the abdominal circumference in the DSA group was significantly larger, the distance from C7 to the coccyx tip in the DSA group was significantly shorter, the number of ultrasound-visible lumbar complexes in the DSA group was significantly more, and the spinal palpation score in the DSA group was significantly lower (P < 0.05). The results of univariate logistic regression analysis showed that body weight, BMI, abdominal circumference, distance from C7 to the coccyx tip, ultrasound-visual lumbar vertebral complexe quantity, and spinal palpation score were associated with the occurrence of DSA (P < 0.05). The results of multivariate logistic regression analysis showed that ultrasound-visual lumbar vertebral complexe quantity ≤ 1 was an independent risk factor for the occurrence of DSA. The ROC curve AUC for predicting DSA by the number of ultrasound visual complexes was 0.900 (95% CI 0.839-0.961), the sensitivity was 0.833, and the specificity was 0.943. The AUC of the ROC curve of the internal validation model was 0.899 (95% CI 0.841-0.949, Z = 14.525, P < 0.001), suggesting good discrimination.
Conclusion: Ultrasound-visible lumbar vertebral complex quantity ≤ 1 effectively predicts DSA in parturients undergoing cesarean section, showing high predictive accuracy. |
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