文章摘要
膈肌厚度比在肌间沟臂丛神经阻滞致膈肌麻痹中的诊断价值
Diagnostic value of diaphragm thickness index in diaphragmatic paralysis caused by interscalene brachial plexus block
  
DOI：10.12089/jca.2024.04.002
中文关键词: 膈肌厚度比  膈肌移动度  用力肺活量  第一秒用力呼气容积  膈肌麻痹  臂丛神经阻滞
英文关键词: Diaphragm thickening index  Diaphragm excursion  Forced vital capacity  Forced expiratory volume in one second  Diaphragmatic paralysis  Brachial plexus block
基金项目:“十四五”江苏省医学重点学科麻醉学（ZDXK202232）
作者单位E-mail
徐敏 210008,南京医科大学鼓楼临床医学院（现在徐州医科大学第二附属医院麻醉科）  
薛硕 南京大学医学院附属鼓楼医院麻醉手术科  
孔明健 徐州医科大学第二附属医院麻醉科  
张伟 210008,南京医科大学鼓楼临床医学院 zhangwei2008@njmu.edu.cn 
摘要点击次数: 267
全文下载次数: 89
中文摘要:
      
目的：评价膈肌厚度比（DTI）在肌间沟臂丛神经阻滞导致膈肌麻痹中的诊断价值。
方法：选择择期行肱骨中段、桡骨骨折内固定或取内固定术的患者51例，男27例，女24例，年龄18～64岁，BMI 18～30 kg/m2，ASA Ⅰ或Ⅱ级。所有患者采用 0.5% 罗哌卡因 20 ml在超声引导下行肌间沟臂丛神经阻滞。以用力呼吸时膈肌移动度（DE）作为标准将患者分为两组：麻痹组（n=11，DE≥25%）和非麻痹组（n=40，DE<25%）。记录阻滞前、阻滞后15 min 阻滞侧DE、吸气末膈肌厚度（DTei）、呼气末膈肌厚度（DTee）、用力肺活量（FVC）、第一秒用力呼气容积（FEV1）、SpO2，感觉、运动阻滞时间和恢复时间，并记录芬太尼用量，给药24 h内恶心、呕吐、声音嘶哑、头痛、霍纳综合征、低血压、呼吸困难等不良反应发生情况。绘制受试者工作特征（ROC）曲线，分析DTI、FVC下降幅度对诊断臂丛神经阻滞所致急性膈肌麻痹的曲线下面积（AUC）和95%可信区间（CI）、界值、敏感性和特异性。
结果：两组阻滞前DE、DTI、FVC、FEV1、SpO2差异无统计学意义。与非麻痹组比较，阻滞后15 min麻痹组DE、DTI明显减小（P＜0.05），DE下降幅度、FVC下降幅度明显增大（P＜0.05），呼吸困难发生率明显升高（P＜0.05）。两组芬太尼用量及其他不良反应差异无统计学意义。阻滞后DTI诊断急性膈肌麻痹的AUC为0.973（95%CI 0.927～1.000），界值1.2，敏感性100%，特异性95%。阻滞后FVC下降幅度诊断急性膈肌麻痹的AUC为0.697（95%CI 0.534～0.860），界值10%，敏感性100%，特异性38%。
结论：与用力肺活量比较，膈肌厚度比对诊断臂丛神经阻滞所致急性膈肌麻痹有较好的诊断价值，且不需要进行术前基线值测量。
英文摘要:
      
Objective: To evaluate the diagnostic value of the diaphragm thickening index (DTI) in diaphragmatic paralysis caused by interscalene brachial plexus block.
Methods: Fifty-one patients, 27 males and 24 females, aged 18-64 years, BMI 18-30 kg/m2, ASA physical status Ⅰ or Ⅱ were selected for internal fixation or internal fixation of mid-humerus and radius fractures. All the patients received ultrasound-guided interscalene brachial plexus block with 0.5% ropivacaine 20 ml. The patients were divided into two groups: the paralytic group (n = 11, DE≥25%) and the non-paralytic group (n = 40, DE<25%), based on the degree of diaphragm excursion (DE) during strenuous breathing. DE, end-inspiratory diaphragm thickness (DTei), end-expiratory diaphragm thickness (DTee), forced vital capacity (FVC), forced expiratory volume in one second (FEV1), SpO2, sensory and motor block time, and recovery time were recorded before and 15 minutes after block, as well as fentanyl dosage. Adverse reactions such as nausea, vomiting, hoarse, headache, Horner syndrome, hypotension, and dyspnea occurred within 24 hours of administration were recorded. Receiver operating characteristic (ROC) curves were drawn to analyze the area under the curve (AUC) and 95% confidence interval (CI), threshold, sensitivity and specificity of DTI and FVC declines in the diagnosis of brachial plexus block induced acute diaphragmatic paralysis.
Results: There was no significant difference in DE, DTI, FVC, FEV1, and SpO2 between the two groups. Compared with the non-paralytic group, DE and DTI of the paralytic group were significantly decreased (P < 0.05), the decrease range of DE and FVC was significantly increased (P < 0.05), and the incidence of dyspnea was significantly increased (P < 0.05). There was no significant difference in fentanyl dosage and other adverse reactions between the two groups. The AUC of DTI for the diagnosis of acute diaphragmatic paralysis after retardation was 0.973 (95% CI 0.927-1.000), while the threshold was 1.2, the sensitivity was 100%, and the specificity was 95%. The AUC for diagnosis of acute diaphragmatic paralysis was 0.697(95% CI 0.534-0.860), while the threshold was 10%, the sensitivity was 100%, and the specificity was 38%.
Conclusion: Compared with forced vital capacity, diaphragmatic thickness index has a better diagnostic value in the diagnosis of acute diaphragmatic paralysis caused by brachial plexus block, and does not require preoperative baseline measurement.
查看全文   查看/发表评论  下载PDF阅读器
关闭