环甲肌肌电图对喉上神经阻滞效果的评估作用

发布时间：2018-04-18 08:33

本文选题：喉肌电图 + 喉上神经阻滞　；参考：《临床麻醉学杂志》2015年08期

【摘要】：目的通过观察喉肌电图中环甲肌肌电募集相对喉上神经阻滞效果评估的准确性,探讨环甲肌肌电图对清醒气管插管评估的准确性。方法困难气道患者14例,麻醉诱导前在舌骨大角平面行喉上神经阻滞,双侧各注入1%利多卡因2ml,口咽部及经环甲膜穿刺气管内1%丁卡因表面麻醉各2ml,后行纤维支气管镜清醒气管插管。喉上神经阻滞效果以临床诊断作判别标准,同时肌电图电极经皮肤检测喉上神经支配的环甲肌肌电募集相。以临床诊断喉上神经阻滞效果佳(阳性)作为评判标准,通过受试者工作特征曲线(ROC曲线)分析环甲肌肌电募集相对喉上神经阻滞效果反应的敏感性和特异性,寻找诊断临界值(cutoff点);采用Spearman检验分析募集相与阻滞效果的相关性。结果环甲肌肌电募集相对喉上神经阻滞效果反应的ROC曲线下面积(AUC)为:0.927(95%CI 0.799~1.000);当肌电募集为减弱"++"相时,敏感度与特异度之和值最大,其敏感性为75.0%,特异性为91.7%;Spearman相关系数r=0.659(95%CI 0.525~0.779,P=0.002)。结论应用环甲肌肌电募集模式对喉上神经阻滞术效果进行评估有很高的准确性。当环甲肌肌电募集减弱为"++"相或以下时,相应侧的声门上黏膜感觉消失,神经阻滞效果佳,可作为判别清醒气管插管时机的指标。
[Abstract]:Objective to observe the accuracy of laryngeal electromyography (LEMG) in evaluating the effect of superior laryngeal nerve block (SCB) on artesian myoelectric recruitment, and to explore the accuracy of RMG in evaluating lucid tracheal intubation.Methods 14 patients with difficult airway were treated with superior laryngeal nerve block at the level of the large angle of hyoid before anesthesia induction.Bilateral injection of 1% lidocaine 2 ml, oropharynx and 1% tetracaine surface anesthesia 2 ml, followed by fiberoptic bronchoscope lucid tracheal intubation.The effect of supralaryngeal nerve block was based on clinical diagnosis, and electromyography electrode was used to detect the electrical recruitment phase of the superior laryngeal nerve.The sensitivity and specificity of the response to the superior laryngeal nerve block were analyzed by using the operating characteristic curve (ROC curve) of the subjects and the sensitivity and specificity of the response to the superior laryngeal nerve block by using the clinical diagnosis of superior laryngeal nerve block.Spearman test was used to analyze the correlation between recruitment phase and block effect.Results the area under the ROC curve of the response to the superior laryngeal nerve block was: 1: 0.92795 CI 0.7991.0000.When the EMG recruitment was weakened, the sum of sensitivity and specificity was the highest, the sensitivity was 75.0 and the specificity was 91.7 Spearman correlation coefficient (r=0.659(95%CI 0.5250.779P0. 002).Conclusion it is accurate to evaluate the effect of superior laryngeal nerve block by ring myoelectric recruitment.When the myoelectric recruitment decreased to "" phase or below, the corresponding supraglottic mucosa sensation disappeared and the nerve block effect was good, which could be used as an index to judge the time of lucid tracheal intubation.
【作者单位】：海南医学院附属医院麻醉科;海南省人民医院麻醉科;
【分类号】：R614

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