皮肤温度变化对截瘫患者下肢神经阻滞效果的评估价值  

Value of skin temperature change for nerve block effect assessment in paraplegic patients

作　　者：王世禄[1] 谢海[1] 马乃全[1] 周期[1] 陈立[1] 符少川[1] 顾颖红[1] 金辉[1] 肖志博[1] 

机构地区：[1]海南医学院第一附属医院麻醉科,海口570102

出　　处：《郑州大学学报（医学版）》2017年第3期303-306,共4页Journal of Zhengzhou University(Medical Sciences)

基　　金：海南省卫计委科学研究项目1601032021A2001

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_阻和T_非)为注药前后皮温的差值,校准的阻滞侧皮温变化值(T_校)=T_阻-T_非。结果:两侧各有232个测量点,T_阻=-(1.8±0.5)℃,T_非=-(0.5±0.3)℃,T_校=-(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_校与神经阻滞效果呈较强的负相关关系(r_S=-0.758,95%CI=-0.790^-0.572)。以T_校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。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 nonblock 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. Tadjustwas negatively correlated with nerve block effect（ rS=-0. 758,95% CI =-0. 790-0. 572）. ROC of Tadjustnerve 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.

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 

分 类 号：R614.4[医药卫生—麻醉学]