文章摘要
股中远段局部组织氧饱和度评估腰丛阻滞后股神经支配区域阻滞效果
Evaluation of local oxygen saturation in the thigh on the blocking effect of femoral nerve innervation after lumbar plexus block
  
DOI：10.12089/jca.2018.12.013
中文关键词: 腰丛神经阻滞  组织氧饱和度  预测
英文关键词: Lumbar plexus block  Regional oxygen saturation  Predict
基金项目:
作者单位E-mail
周雯 410008,长沙市,中南大学湘雅医院麻醉科  
邹宇 410008,长沙市,中南大学湘雅医院麻醉科  
唐朝辉 410008,长沙市,中南大学湘雅医院麻醉科  
熊云川 410008,长沙市,中南大学湘雅医院麻醉科  
谢咏秋 410008,长沙市,中南大学湘雅医院麻醉科  
郭曲练 410008,长沙市,中南大学湘雅医院麻醉科  
黄长盛 410008,长沙市,中南大学湘雅医院麻醉科 docthuang2005@hotmail.com 
摘要点击次数: 3371
全文下载次数: 1113
中文摘要:
      
目的 观察单侧腰丛神经阻滞患者股神经支配区局部组织氧饱和度(regional oxygen saturation, rSO2)变化与阻滞效果的关系,探讨rSO2预测阻滞效果的准确性。
方法 选择择期单侧下肢手术患者31例,男14例,女17例,年龄18～80岁,ASA Ⅰ—Ⅲ级,根据是否阻滞成功将患者分为两组:阻滞成功组(n=26)和阻滞失败组(n=5)。腰丛阻滞后15 min内连续监测股神经支配的股中段及远段区域的rSO2,与对侧肢体相同部位校正后,股中段和股远段分别记录为ΔrSO2-M和ΔrSO2-D,采用受试者工作特征(ROC)曲线分析rSO2预测股神经阻滞效果的诊断临界值。
结果 腰丛阻滞后15 min内阻滞成功组ΔrSO2-M和ΔrSO2-D明显升高(P<0.05),阻滞失败组无明显变化。ΔrSO2-M升高预测的曲线下面积(area under curve, AUC)明显高于ΔrSO2 D和针刺试验。ΔrSO2 M预测的最大曲线下面积为0.885 (95％CI 0.742～1.000),临界值取6.5时,灵敏度和特异度分别为69.2％和100.0％。阻滞后15 min,ΔrSO2-M联合针刺试验预测的AUC、灵敏度和特异度分别为0.954 (95％CI 0.881～1.000)、88.5％和100.0％。
结论 rSO2变化可用于预测腰丛阻滞后股神经支配区域是否阻滞成功。与针刺试验以及ΔrSO2-D变化比较,ΔrSO2-M升高预测的准确性更高。ΔrSO2-M联合针刺试验可进一步提高其预测准确性。
英文摘要:
      
Objective To observe the regional oxygen saturation (rSO2)changes in the femoral nerve innervation area and to explore the accuracy of the rSO2 in the thigh changes in predicting the effect of nerve block in unilateral lumbar plexus block patients.
Methods Thirty-one patients with elective unilateral lower extremity surgery were enrolled, including 14 males and 17 females, aged 18-80 years, falling into ASA physical status Ⅰ-Ⅲ. Patients were divided into two groups according to whether the block was successful: block success (n = 26) and block failure (n = 5). rSO2 was continuously monitored in the middle and distal femoral innervations within 15 minutes after lumbar plexus block. After correction at the same part of the contralateral limb, the middle and distal femoral segments were recorded as rSO2-M and rSO2-D respectively. The receiver operating characteristic curve (ROC) showed the sensitivity and specificity of rSO2 changes in predicting the effect of femoral nerve block, and the diagnostic cutoff value was found.
Results ΔrSO2-M and ΔrSO2-D increased significantly with the successful group, but not with the failed group. The area under the curve (AUC) of the ROC of ΔrSO2-M changes in the thigh responding to the effects of block was 0.885 (95％CI 0.742 - 1.000), The cutoff value was 6.5, whose sensitivity and specificity was 69.2％ and 100.0％, respectively. A combination of ΔrSO2-M and pinprick further enhanced the sensitivity to 88.5％, still with 100.0％ specificity, and AUC was 0.954 (95％CI 0.881 - 1.000).
Conclusion An increase in ΔrSO2, especially in the middle anterior thigh, measured as ΔrSO2-M, indicates successful femoral blockade after LPB. ΔrSO2-M joint pinprick can further improve the prediction accuracy.
查看全文   查看/发表评论  下载PDF阅读器
关闭