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。
Objective To explore the accuracy of cricothyroid muscle electromyography in evaluating the effect of superior laryngeal nerve block, by observing the correlation of cricothyroid muscle recruitment potentials and effect of superior laryngeal nerve block. Methods Fourteen difficult airway patients underwent awake intubation were selected for the trial. 1 % lidoeaine 2 ml were injected at the level of thyrohyal at each side for bilateral superior laryngeal nerve block. 1% tetracaine 2 ml for topical anesthesia were administrated on the surface of laryngeal, pharynx and trachea via thyrocricocentesis before endotracheal intubation guided by fiberoptic bronchoseopy. Clinic diagnosis was used as the standard to evaluate the effect of superior laryngeal nerve block. The recruitment potentials of the cri- cothyroid muscle, which was controlled by superior laryngeal nerve, was detected. With valid superior laryngeal nerve block （positive） as a criterion, the sensitivity and specificity ability to predict nerve block result via crieothyroid muscle recruitment potentials was assessed by analysis of the receiver operating characteristic curve （ROC）. The diagnostic cut-off value was determined. Spearman correla- tion was analyzed for the correlation between them. Results The values of patients＇ AUC of the ROC of cricothyroid muscle recruitment potentials responding to superior laryngeal nerve block were 0. 927 （95%CI 0. 799-1. 000）. Importantly, the sum of the sensitivity and specificity was maximum with the sensitivity of 75.0% and the specificity of 91.7%, when the recruitment potentials declined to ＋＋. The Spearman＇s correlation coefficient r=0. 659（95%CI 0. 525-0. 779,P=0. 002）. Conclusion This study demonstrated the high accuracy of cricothyroid muscle recruitment potentials in evaluating the result of superior laryngeal nerve block. When value of cricothyroid muscle recruitment potentials declined to ＋ ＋, the sense of supraglottic mucosa on the corresponding side was absent and the superior
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2015年第8期766-769,共4页
Journal of Clinical Anesthesiology
关键词
喉肌电图
喉上神经阻滞
肌电募集
Laryngeal electromyography
Superior laryngeal nerve block
Recruitment potentials
