腹横肌平面阻滞区皮肤温度变化对阻滞效果的评估

doi:10.6040/j.issn.1671-7554.0.2015.214

摘要/Abstract

摘要： 目的观察超声引导下腹横肌平面阻滞(TAP)区域内皮肤温度变化对点痛觉的反应性,探讨阻滞区域内温度变化对阻滞效果评估的准确性。方法选择下腹部手术30例,在手术前行双侧超声引导下TAP,超声确定到达腹横肌平面后,注入0.25%罗哌卡因30 mL。随机在阻滞区域内取4个测量点,采用针刺法测量注药后10 min的点痛觉,并记录测量点注药前、注药后10 min皮肤温度的变化值。以点痛觉缺失(阳性)作为评判阻滞效果的标准,通过受试者工作特征曲线(ROC)分析阻滞区域内温度变化对点痛觉反应的敏感性与特异性;Pearson相关分析两者的相关性。结果阻滞区域内温度变化对点痛觉反应的ROC曲线下面积(AUC)为:0. 882(95%CI 0.796~0.968);阻滞区域内温度变化幅度1.25 ℃时,敏感性与特异性之和值最大,其敏感性为84.4%,特异性为79.2%;Pearson相关系数:r=0.671(95%CI 0.465~0.670)。结论 TAP后皮肤温度变化对评估阻滞效果有较高的准确性,可用于痛觉评估不可行情况下的神经阻滞效果评估。

关键词: 腹横肌平面阻滞, 温度, 神经阻滞, 超声引导, 疼痛

Abstract: Objective To observe the reactivity of skin temperature changes on blocked area responding to pinprick testing in ultrasound-guided transversus abdominis plane(TAP), and to explore the accuracy of the temperature changes for nerve block effect. Methods A total of 30 patients who underwent lower abdominal surgery were enrolled. Bilateral ultrasound-guided transversus abdominis plane block was performed before operation. After transversus abdominis plane was determined via ultrasound, 30 mL 0.25% ropivacaine was administered for one side. And then 4 points within the blocked area for pinprick testing were randomly selected, and the results of needle test after 10 min and skin temperature changes before and 10 min after injection were obtained. With the point analgesia(positive)as a criterion, the sensitivity and specificity to predict pain via temperature was assessed by analyzing the receiver operating characteristic curve(ROC). The correlation was assessed by calculating Pearson correlation analysis. Results The patients' ROC value of skin temperature changes on blocked area responding to the pain assessment was AUC 0. 882(95% CI 0.796-0.968). Importantly, the ROC analysis displayed that the diagnostic cut-off value was 1.25 ℃, with sensitivity being 84.4% and specificity being 79.2%. The value of Pearsons correlation coefficient was r=0.671(95% CI 0.465-0.67). Conclusion Changes of skin temperature in blocked area after transversus abdominis plane shows high accuracy responding to nerve block effect, which makes skin temperature measuring a good way in determining block success when sensory testing is impossible.

Key words: Ultrasound guided, Transversus abdominis plane, Nerve block, Analgesia, Temperature measuring

中图分类号:

R614.4

谢海,李艳,周期. 腹横肌平面阻滞区皮肤温度变化对阻滞效果的评估[J]. 山东大学学报（医学版）, 2016, 54(1): 71-74.

XIE Hai, LI Yan, ZHOU Qi. Assessment of skin temperature changes in determining success of transversus abdominis plane block[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2016, 54(1): 71-74.

参考文献

[1] Yu N, Long X, Lujan-Hernandez JR, et al. Transversus abdominis-plane block versus local anesthetic wound infiltration in lower abdominal surgery: a systematic review and meta-analysis of randomized controlled trials[J]. BMC Anesthesiol, 2014, 15(14): 121-132.
[2] Park JS, Choi GS, Kwak KH, et al. Effect of local wound infiltration and transversus abdominis plane block on morphine use after laparoscopic colectomy: a nonrandomized, single-blind prospective study[J]. J Surg Res, 2014, 23(14): 1604-1618.
[3] Lapmahapaisan S, Tantemsapya N, Aroonpruksakul N, et al. Efficacy of surgical transversus abdominis plane block for postoperative pain relief following abdominal surgery in pediatric patients[J]. Paediatr Anaesth, 2015, 9(13): 111-135.
[4] Fiala T. Tranversus abdominis plane block during abdominoplasty to improve postoperative patient comfort[J]. Aesthet Surg J, 2015, 35(1): 72-80.
[5] Kokulu S, Bakı ED, Kaçar E, et al. Effect of transversus abdominis plane block on cost of laparoscopic cholecystectomy anesthesia[J]. Med Sci Monit, 2014, 23(20): 2783-2787.
[6] 朱常花, 王琛, 谢红. 超声引导下腹横肌平面阻滞镇痛有效性的初步观察[J]. 苏州大学学报:医学版, 2011, 31(3): 488-490. ZU Changhua, WANG Chen, XIE Hong. The effectiveness of ultrasound-guided transversus abdominis plane block on analgesia: A preliminary observational study[J]. Suzhou University Journal of Medical Science, 2011, 31(3): 488-490.
[7] 王武涛, 李争卫, 何爱萍. 腹横肌平面阻滞对阑尾切除术术后镇痛及患者恢复情况的影响[J]. 临床麻醉学杂志, 2014, 30(10): 998-1000. WANG Wutao, LI Zhengwei, HE Aiping. The effect of transversus abdominis plane block on post-operation analgesia and quality of recovery at appendectomy[J]. Journal of Clinical Anesthesiology, 2014, 30(10): 998-1000.
[8] 周雁, 敦元莉, 林惠华, 等. 超声引导下经腹横筋膜平面阻滞在经腹子宫手术术中和术后的镇痛效果评价[J]. 吉林大学学报(医学版), 2013, 39(6): 1264-1269. ZHOU Yan, GUO Yuanli, LIN Huihua, et al. Evaluation on intra- and post-operative analgesic efficacy of ultrasound-guided transversus abdominis plane block in patients undergoing abdominal uterine surgery[J]. Journal of Jilin University(Medicine Edition), 2013, 39(6): 1264-1269.
[9] Lissauer J, Mancuso K, Merritt C, et al. Evolution of the transversus abdominis plane block and its role in postoperative analgesia[J]. Best Pract Res Clin Anaesthesiol, 2014, 28(2): 117-126.
[10] Mugita M, Kawahara R, Tamai Y, et al. Effectiveness of ultrasound-guided transversus abdominis plane block and rectus sheath block in pain control and recovery after gynecological transumbilical single-incision laparoscopic surgery[J]. Clin Exp Obstet Gynecol, 2014, 41(6): 627-632.
[11] 高志屹, 程斌. 超声引导下腹横肌平面阻滞用于下腹部手术术后镇痛的效果[J]. 临床麻醉学杂志, 2014,30(12): 1190-1192. GAO Zhiyi, CHENG Bin. Clinical application of ultrasound-guided transversus abdominis plane block for postoperative analgesia in patients received lower abdominal surgery[J]. Journal of Clinical Anesthesiology, 2014, 30(12): 1190-1192.
[12] Keller DS, Ermlich BO, Delaney CP, et al. Demonstrating the benefits of transversus abdominis plane blocks on patient outcomes in laparoscopic colorectal surgery: review of 200 consecutive cases[J]. J Am Coll Surg, 2014, 219(6): 1143-1148.
[13] Kadam VR. Ultrasound guided quadratus lumborum block or posterior transversus abdominis plane block catheter infusion as a postoperative analgesic technique for abdominal surgery[J]. J Anaesthesiol Clin Pharmacol, 2015, 31(1): 130-131.
[14] Zhang P, Deng XQ, Zhang R, et al. Comparison of transversus abdominis plane block and epidural analgesia for pain relief after surgery[J]. Br J Anaesth, 2015, 114(2): 339.
[15] van Haren FG, Kadic L, Driessen JJ. Skin temperature measured by infrared thermography after ultrasound-guided blockade of the sciatic nerve[J]. Acta Anaesthesiol Scand, 2013, 57(9): 1111-1117.

相关文章 14

[1]	张振伟,范晓艳,张云华,蒋仲敏. 持续胸椎旁神经阻滞在多发肋骨骨折镇痛方面的应用[J]. 山东大学学报（医学版）, 2016, 54(6): 39-42.
[2]	赵阳, 娄凤兰. 慢性疼痛患者阿片类药物异常用药行为及相关因素[J]. 山东大学学报（医学版）, 2015, 53(8): 87-91.
[3]	孙卓浩, 刘妍, 周冬梅, 李伟. 阿米替林治疗痛性糖尿病周围神经病变的临床研究[J]. 山东大学学报（医学版）, 2015, 53(5): 81-84.
[4]	张庆, 陈萍. “三阶梯法”用于肿瘤科实习护士癌性疼痛教育的体会[J]. 山东大学学报（医学版）, 2014, 52(Z2): 192-193.
[5]	林波, 李曦光, 廖华君. 传统推拿手法配合神经阻滞疗法治疗神经根型颈椎病的疗效观察[J]. 山东大学学报（医学版）, 2014, 52(S1): 55-56.
[6]	孔繁莉, 席雅琳, 高羽. 临床药师对癌症患者疼痛治疗的药学监护[J]. 山东大学学报（医学版）, 2014, 52(S1): 45-45.
[7]	潘黎静,戴燕燕. 甲状腺冰冻切片制作方法的探讨[J]. 山东大学学报（医学版）, 2014, 52(5): 100-103.
[8]	黄海真1，胡启雅1，丁超1，郭亚秋1，齐峰1，任杰2，潘晓军1. 罗哌卡因聚乙二醇-聚乳酸微球对切口痛模型大鼠坐骨神经阻滞的时效[J]. 山东大学学报（医学版）, 2014, 52(3): 50-55.
[9]	孙传玉，郭蕾，毕严斌. 超声引导下股神经与坐骨神经联合阻滞在抗凝患者大隐静脉高位结扎与剥脱术中的应用[J]. 山东大学学报(医学版), 2013, 51(10): 77-80.
[10]	刘聪聪，肖静，时丹丹，刘妍，李海英，周炜，张开宁，王蒙，李杰. 彩超引导下经皮肾穿刺造瘘引流术的临床价值[J]. 山东大学学报(医学版), 2013, 51(1): 75-78.
[11]	杨红卫. MAPK在弗司可林诱发的脊髓背角LTP中的作用[J]. 山东大学学报(医学版), 2010, 48(6): 53-56.
[12]	. 异丙酚对热应激大鼠脑[J]. 山东大学学报(医学版), 2009, 47(10): 72-74.
[13]	张兆航,杜洪玫,张丽,李东亮. 瑞芬太尼联合氯诺昔康用于全麻患者苏醒期清醒无痛拔管[J]. 山东大学学报(医学版), 2008, 46(1): 104-107.
[14]	李成利,武乐斌,宋吉清,吕玉波,张传臣. 开放式磁共振导引下腹腔神经丛阻滞毁损术的应用[J]. 山东大学学报(医学版), 2007, 45(3): 299-302.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed