国际麻醉学与复苏杂志   2016, Issue (9): 4-4
    
全身麻醉下小儿皮肤温度变化对臂丛神经阻滞效果的评估
李艳, 谢海1()
1.海南医学院附属医院
Assessment of skin temperature changes in determining the success of axillary brachial plexus block under general anesthesia in pediatrics
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摘要:

目的 通过观察小儿全身麻醉复合超声引导腋路臂丛神经阻滞下的阻滞区域内皮肤温度变化与阻滞效果之间的关系,探讨温度变化对阻滞效果评估的准确性。 方法 选择小儿手部手术30例,全身麻醉喉罩通气,行超声引导下腋路臂丛神经阻滞,在靠近肌皮神经、桡神经、尺神经和正中神经周围各注入1 ml/kg总量1/4的0.25%罗哌卡因。随机在阻滞的各个神经分支支配的皮肤区域内取一个测量点,记录神经阻滞前、阻滞后15 min皮肤温度的变化值。以阻滞效果作为评判的标准,通过受试者工作特征(receiver operator characteristic, ROC)曲线分析阻滞区域内温度变化对阻滞效果反应的敏感度和特异性,寻找诊断临界值(cutoff值);Spearman相关分析两者的相关性。 结果 阻滞区域内温度变化对阻滞效果反应的ROC曲线下面积(area under roc curve, AUC)为0.886[95%置信区间(confidence interval, CI):0.815~0.957];阻滞区域内温度变化幅度为0.65 ℃时,敏感度与特异性之和值最大,其敏感度为86.4%,特异性为94.1%;Spearman相关系数:r=0.773(95%CI:0.656~0.840)。 结论 皮肤温度变化对评估阻滞效果有较高的准确性,可以用于全身麻醉下小儿腋路臂丛神经阻滞后阻滞效果的评价。

关键词: 臂丛神经阻滞; 小儿; 皮肤温度; 麻醉作用
Abstract:

Objective To observe the skin temperature changes induced by ultrasound-guided axillary brachial plexus block in pediatrics under general anesthesia and explore the accuracy of the temperature changes in predicting the effect of nerve block. Methods Thirty pediatric patients undergoing upper extremity surgery were selected for this study. After anesthesia induction, a laryngeal mask airway was inserted, and then the ultrasound-guided axillary brachial plexus block was performed. After the block sites were determined, one quarter of the total dose(1 ml/kg) of 0.25% ropivacaine was injected around the four main branches of axillary brachial plexus, respectively. The testing sites of each block area were randomly selected. The skin temperature at the time of 15 min before nerve block and 15 min after were recorded, and the skin temperature changes were calculated. The sensitivity and specificity of the temperature changes in determining the success of axillary brachial plexus block was assessed by using the receiver operating characteristic(ROC) curve. Spearman correlation was used to analyze the correlation between them. Results The value of area under curve(AUC) of the ROC of the skin temperature changes in blocked area were 0.886[95% confidence interval(CI): 0.815-0.957]. The addition of the sensitivity and specificity arrived the maximum at the diagnostic cut-off value of 0.65 ℃, which was 86.4% and 94.1%, respectively. The value of Spearman′s correlation coefficient was 0.773(95%CI: 0.656-0.840). Conclusions The present study demonstrated that the changes of the skin temperature in blocked area have a high accuracy in predicting the effect of nerve block, which can be used in determining the success of axillary brachial plexus block under general anesthesia in pediatrics.

Key words: Brachial plexus nerve block; Pediatric; Skin temperature; Anesthetic action