手掌心和腋窝区域皮肤温度变化对乳腺癌患者胸椎旁神经阻滞效果的评估  

Assessment of palm and axillary temperature changes in determining the success of thoracic paravertebral block in breast cancer patients

作　　者：李艳 谢海[2] 向伟[1] 吴多志[3] 周期[2] 马乃全[2] 欧阳碧山[3] LI Yan , XIE Hai , XIANG Wei , WU Duozhi , ZHOU Qi , MA Naiquan, OUYANG Bishan.(Department of Anesthesiology, Hainan Provincial Maternal and Child Health Hospital, Haikou 570206, Chin)

机构地区：[1]海南省妇幼保健院麻醉科,海口市570206 [2]海南医学院第一附属医院麻醉科 [3]海南省人民医院麻醉科

出　　处：《临床麻醉学杂志》2018年第2期130-133,共4页Journal of Clinical Anesthesiology

基　　金：海南省卫生厅科学研究课题(1601032021A2002)

摘　　要：目的观察超声引导下胸椎旁神经阻滞的乳腺癌患者手掌心和腋窝区域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。方法选择行择期乳腺癌改良根治术患者120例,均为女性,年龄29~67岁,ASAⅠ~Ⅲ级。全麻之前行超声引导下T3~4胸椎旁神经阻滞,在胸椎旁间隙注入0.25%罗哌卡因25 ml。随机在阻滞侧和非阻滞侧的手掌心和腋窝区域皮肤各取一个测量点,记录神经阻滞前、阻滞后15 min的皮肤温度。以神经阻滞效果佳(阳性)、神经阻滞效果差(阴性)作为评判标准,采用受试者工作特征曲线(receiver operating characteristic curve,ROC)分析手掌心和腋窝区域皮肤温度变化对阻滞效果反应的敏感性和特异度,寻找诊断临界值(cutoff值);Pearson分析温度变化和阻滞效果的相关性。结果手掌心温度变化的曲线下面积(area under curve,AUC)(AUC手掌心)为0.892(95%CI 0.803~0.947),Cutoff值为0.9℃,其敏感度为87.3%,特异性为75.9%;腋窝温度变化的AUC(AUC腋窝)为0.813(95%CI 0.756~0.884),Cutoff值为0.4℃,其敏感度为80.7%,特异性为71.6%;AUC手掌心明显大于AUC腋窝(P<0.05)。结论手掌心和腋窝区域皮肤温度变化对评估T3~4胸椎旁神经阻滞效果有较高的准确性,可以用于T3~4胸椎旁神经阻滞效果的评价;手掌心皮肤温度变化对阻滞效果评估的准确性高于腋窝皮肤温度。Objective To observe the skin temperature changes on blocked area of ultrasound- guided thoracic paravertebral block and to explore the accuracy of the temperature changes in predic- ting the effect of nerve block in breast cancer patients. Methods One hundred and twenty breast cancer patients undergoing modified radical mastectomy, aged 29-67 years, ASA physical status Ⅰ-Ⅲ, were selected for the study. Before general anesthesia induction, ultrasound-guided thoracic para- vertebral block was performed. After the block site Ta4 was determined, 25 ml 0. 25% ropivacaine was injected around the thoracic paravertebral space. The skins of palm and axillary regions both in blocked and unblocked sites were randomly selected. The skin temperature before nerve block and 15 min after were recorded, and the skin temperature changes were calculated. The sensitivity and speci- ficity of the temperature changes in determining the effect of thoracic paravertebral block was assessed by using the receiver operating characteristic curve （ROC）. Pearson correlation was used to analyze the correlation. Results The value of area under curve （AUC） of the ROC of the skin temperature changes in palm regions responding to the effects of block was 0. 892 （95%CI 0. 803-0. 947）. The cut-off value was 0.9℃ which sensitivity and specificity was 87.3% and 75.9%, respectively. The AUC in axillary regions was 0. 813 （95%CI 0. 756 0. 884）, the cut-off value was 0.4℃ which sensi- tivity and specificity was 80.7%and 71.6%, respectively. The value of AUC in palm regions was lar- ger than in axillary regions （P〈0.05）. Conclusion The present study demonstrated that the changes of the skin temperature in palm and axillary regions have a high accuracy in predicting the effect of T3 4 thoracic paravertebral block, which can be used in determining the success of T3-4 thoracic para- vertebral block. The assessment of temperature changes in palm regions is more accuracy than in axil- lary.

关 键 词：胸椎旁神经阻滞 乳腺癌 改良根治术 手掌心温度 腋窝区温度 

分 类 号：R614[医药卫生—麻醉学] R737.9[医药卫生—外科学]