[1]王世禄,谢 海#,马乃全,等.皮肤温度变化对截瘫患者下肢神经阻滞效果的评估价值*[J].郑州大学学报(医学版),2017,(03):303-306.[doi:10.13705/j.issn.1671-6825.2017.03.015]
 WANG Shilu,XIE Hai,MA Naiquan,et al.Value of skin temperature change for nerve block effect assessment in paraplegic patients[J].JOURNAL OF ZHENGZHOU UNIVERSITY(MEDICAL SCIENCES),2017,(03):303-306.[doi:10.13705/j.issn.1671-6825.2017.03.015]
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皮肤温度变化对截瘫患者下肢神经阻滞效果的评估价值*()
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《郑州大学学报(医学版)》[ISSN:1671-6825/CN:41-1340/R]

卷:
期数:
2017年03期
页码:
303-306
栏目:
应用研究
出版日期:
2017-05-15

文章信息/Info

Title:
Value of skin temperature change for nerve block effect assessment in paraplegic patients
作者:
王世禄谢 海#马乃全周 期陈 立符少川顾颖红金 辉肖志博
海南医学院第一附属医院麻醉科 海口 570102
Author(s):
WANG Shilu XIE Hai MA Naiquan ZHOU Qi CHEN Li FU Shaochuan GU Yinghong JIN Hui XIAO Zhibo
Department of Anesthesiology, the First Affiliated Hospital,Hainan Medical College, Haikou 570102
关键词:
股神经阻滞 坐骨神经阻滞 皮肤温度 神经阻滞效果 截瘫
Keywords:
femoral nerve block sciatic nerve block skin temperature nerve block effect paraplegia
分类号:
R614.4
DOI:
10.13705/j.issn.1671-6825.2017.03.015
摘要:
目的:探讨皮肤温度(皮温)变化对感觉缺失区域神经阻滞效果的评估价值。方法:选择择期行下肢肌痉挛松解手术的截瘫患者58例,在手术侧行超声引导下单侧股神经+坐骨神经阻滞,股神经周围注射2.5 mg/L罗哌卡因15 mL,坐骨神经周围注射5.0 mg/L 罗哌卡因10 mL。随机在两侧下肢股神经支配的股内侧肌区域、隐神经支配的小腿内侧区域、坐骨神经支配的股二头肌区域、小腿腓肠肌区域皮肤上各取一个测量点,记录注药前、注药后5 min的皮温。阻滞侧和非阻滞侧皮温变化值(T和T)为注药前后皮温的差值,校准的阻滞侧皮温变化值(T)= T-T。结果:两侧各有232个测量点,T=-(1.8±0.5)℃,T=-(0.5±0.3)℃,T=-(1.2±0.6)℃。其中阻滞侧202个点神经阻滞效果佳,30个点神经阻滞效果差。T与神经阻滞效果呈较强的负相关关系(rS=-0.758,95%CI=-0.790~-0.572)。以T对神经阻滞效果绘制ROC,则曲线下面积为0.912(95%CI=0.806~0.973),诊断临界值为-1.2 ℃,此时的诊断敏感度达83.3%,特异度达81.7%。结论:皮温变化是评估皮肤感觉缺失情况下神经阻滞效果的有价值指标。
Abstract:
Aim: To explore the value of skin temperature change for nerve block effect assessment in paraplegic patients.Methods: A total of 58 paraplegic patients underwent lower extremities myospasmolysis surgeries were selected. Ultrasound-guided unilateral femoral nerve block(2.5 mg/L ropivacaine 15 mL)and sciatic nerve block(5.0 mg/L ropivacaine 10 mL)were performed before operations. The temperature testing points were randomly selected in medial vastus muscle skin area innerved by femoral nerve, medial crural skin area innerved by saphenous nerve, biceps femoral muscle skin area innerved by sciatic nerve, gastrocnemius muscle skin area innerved by sciatic nerve from the two sides. Skin temperature was tested before local anesthetics injection and 5 min after injection. The skin temperature change(T)before and after injection was recorded. The block side adjusted T(Tadjust)was the difference value of T between block side and non-block side.Results: There were 232 measurement points at each side, Tblock=-(1.8±0.5)℃,Tnon-block=-(0.5±0.3)℃,Tadjust=-(1.2±0.6)℃. Nerve block effect of 202 points was good, and that of 30 points was poor. Tadjust was negatively correlated with nerve block effect(rS=-0.758, 95%CI=-0.790-0.572). ROC of Tadjust nerve block effect was drawn, and the area under curve was 0.912(95%CI=0.806-0.973), the diagnostic threshold was -1.2 ℃, at this point,the sensitivity was 83.3%, and specificity was 81.7%.Conclusion: Skin temperature change may be valuable for nerve block effect assessment.

参考文献/References:

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备注/Memo

备注/Memo:
*海南省卫计委科学研究项目 1601032021A2001
#通信作者,男,1979年11月生,硕士,副主任医师,研究方向:疼痛,E-mail:hnxh2003@163.com
更新日期/Last Update: 2017-05-20