摘要
背景尽管有报道说皮肤温度的变化比针刺痛或冷温度感觉对阻滞效果的评定更具敏感性和特异性，但以前应用的方法是计算机辅助的红外温度记录法，该技术花赞大且需要一定的人员培训。在这项前瞻性的观察研究中，我们评估简易的红外温度计是否能可靠地预测锁骨下臂丛神经的阻滞效果。方法30例在锁骨下臂丛神经阻滞下行上技手术的患者纳入本研究。局部麻醉药（以下简称局麻药）注射后在4个主要神经分布区域监测皮肤温度，且5分钟评价一次感觉阻滞的效果（用无痛温觉为0到正常感觉为2）共记录30分钟。注入局麻药后30分钟内4个主要神经分布区域（桡神经、尺神经、正中神经和肌皮神经）的痛温觉消失评分为0视为阻滞成功。皮肤温度的测定采用非接触的温度传感器。结果阻滞120支神经（每例患者4支神经，共30例患者）。其中25例患者成功，4例患者因阻滞失败需补充给药，1例患者改用了全麻。不同神经分布区域的皮肤温度变化没有差异。和阻滞前相比，神经阻滞区域皮肤温度的升高有统计学意义（P〈0．0001，T5-T30）。同一时间神经阻滞区域和非神经阻滞区域的皮肤温度变化有明显的差异（P〈0．05，T5且P〈0．0001，T10～T30）。在某个特定的感觉区域，当5分钟和10分钟时皮肤温度升高1℃或者更高，该神经即被阻滞（评分为0）。因此，5分钟和10分钟时4个神经分布区域的皮肤温度变化明显，30分钟时神经即阻滞成功。监测显示对侧上肢或中心体温没有变化。结论用红外线温度计监测皮肤温度是判断神经阻滞成功与否的可靠、简单且及时的指标。
BACKGROUND： Although it has been reported that an incTease in skin temperature indicates block success with higher specificity and sensibility than skin sensitivity to pinprick and cold, the methodology previously used computerassisted infrared thermography, a technique that is expensive and requires substantial personnel training. In this prospective observational study, we evaluated whether a simple infrared thermometer can reliably predict block effectiveness after infraclavicular brachial plexus blockade. METHODS： Thirty consecutive patients undergoing upper limb surgery under infraclavicular block were enrolled. From the end of the local anesthetic injection, skin temperature was measured in all four maior nerve distribution areas, and the sensory block onset （using cold and pinprick with 0 = no sensation to 2 = normal） were evaluated every 5 rain for 30 min. A successful block was defined as the absence of sensation to cold （swab soaked with alcohol） and pinprid~ （needle） with a score of ＂0＂ within 30 rain after the iniection in the 4 maior nerve distribution areas （radial, ulnar, median and musculocutaneous）. Skin temperature raeasurements were performed using a noncontact temperature probe. RESULTS： One-hundred-twenty nerves （30 patients, 4 nerves per patient） were anesthetized. Twenty-five patients had a successful block. Four patients required supplementation for block failure. General anesthesia was performed in one patient. Skin temperature variation was not different among different nerves. There was a statistically significant increase in cutaneous temperature after nerve block compared to the same skin area before the procedure （P 〈 0. 0001 from T5 to T30）. Average temperature variations in blocked versus unblocked nerves at the same time were significantly different （P 〈 0.03 at T5 then P 〈 0. 0001 from T10 to T30）. When temperature in a specific sensory territory increased 1 ℃ or more, at 5 and 10 rain, the specific nerve was blocked （the score was
作者
Vincent Minville, MD
Agnes Gendre, MD
Jan Hirsch, MD
Stein Silva, MD
Benoit Bourdet, MD
Carole Barbero, MD
Olivier Fourcade, MD, PhD
Kamran Samii, MD
Herve Bouaziz, MD, PhD
王超平(译)
喻田(校)
出处
《麻醉与镇痛》
2011年第4期84-87,共4页
Anesthesia & Analgesia
