皮肤温度变化对截瘫患者下肢神经阻滞效果的评估价值

发布时间：2018-05-19 07:48

  本文选题：股神经阻滞 + 坐骨神经阻滞　； 参考：《郑州大学学报(医学版)》2017年03期

【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。
[Abstract]:Objective: to evaluate the effect of skin temperature on nerve block in sensory missing area. Methods: Fifty-eight paraplegic patients undergoing spasticity of lower extremity were selected and treated with unilateral sciatic nerve block guided by ultrasound. Ropivacaine (2.5 mg/L) was injected around the femoral nerve (15 mL) and ropivacaine (5.0 mg/L) was injected around the sciatic nerve (10 mL). The medial femoral muscles innervated by the lower extremities, the medial region of the leg innervated by the saphenous nerve, the biceps femoris muscle innervated by the sciatic nerve and the gastrocnemius muscle region of the leg were randomly selected at random. The skin temperature 5 min after injection. The change of skin temperature in the block side and the non-block side was the difference of the skin temperature before and after injection, and the calibrated change value of the skin temperature of the block side was T _ corrected. Results: there were 232 measuring points on each side, T1. 8 卤0. 5) 鈩，

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