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.

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