下肢动脉血流参数预测坐骨神经阻滞的有效性

Efficacy of lower extremity arterial blood flow parameters predicting sciatic nerve block

目的观察坐骨神经阻滞(SNB)后下肢肢端区域血流动力学的变化,探讨其预测SNB效果的临床效能。方法选择行择期下肢骨科手术患者67例,男27例,女40例,年龄20~60岁,BMI 20~27 kg/m^(2),ASAⅠ或Ⅱ级。患者接受超声引导下SNB,患肢单侧注射0.3%罗哌卡因20 ml。记录SNB前1 min、SNB后5、10、20、30、40 min阻滞侧胫前动脉区域和胫后动脉区域的动脉血流参数,包括收缩期峰值流速(PSV)、舒张末期流速(EDV)、时间-平均速度(TAmean)和时间-最大平均速度(TAmax)。阻滞后45 min,Hollmen评分≥2分的患者被定义为SNB阻滞成功。根据SNB是否阻滞成功将患者分为两组:SNB成功组(S组,Hollmen评分≥2分)和SNB失败组(F组,Hollmen评分<2分)。绘制SNB完成后10 min时区域血流动力学参数变化率的受试者工作特征(ROC)曲线,并计算曲线下面积(AUC)和95%可信区间(CI)以预测SNB效果。结果本研究最终阻滞成功患者59例(88.1%)。构建SNB后10 min时区域血流动力学参数变化率的ROC曲线。胫前动脉区域PSV的AUC为0.893(95%CI 0.780~1.000),截断值19.22%,敏感性86.7%,特异性90.0%。EDV的AUC为0.748(95%CI 0.615~0.880),截断值48.65%,敏感性75.0%,特异性72.7%。TAmean的AUC为0.827(95%CI 0.728~0.925),截断值72.88%,敏感性68.3%,特异性100%。TAmax的AUC为0.850(95%CI 0.763~0.937),截断值82.12%,敏感性70.5%,特异性100%。胫后动脉区域PSV的AUC为0.880(95%CI 0.790~0.970),截断值35.9%,敏感性68.3%,特异性100%。EDV的AUC为0.786(95%CI 0.659~0.913),截断值49.8%,敏感性81.7%,特异性70.0%。TAmean的AUC为0.804(95%CI 0.701~0.908),截断值53.3%,敏感性68.3%,特异性90.9%。TAmax的AUC为0.852(95%CI 0.758~0.947),截断值45.9%,敏感性76.7%,特异性90.0%。结论区域血流动力学参数可以作为临床医师早期预测SNB效果的良好指标。

Objective To investigate the hemodynamic changes in the lower after sciatic nerve block(SNB),and to explore its clinical efficacy in predicting successful SNB.Methods Patients who underwent elective lower extremity orthopedic surgery were selected,including 27 males and 40 females,aged 20-60 years,BMI 20-27 kg/m^(2),ASA physical statusⅠorⅡ.All of the patients underwent ultrasonic guidance SNB,and the blood flow values of the anterior tibial artery region and posterior tibial artery region were recorded 1 minute before SNB and 5,10,20,30,40,and 45 minutes after SNB on the blocked side,including peak systolic velocity(PSV),end-diastolic velocity(EDV),time-mean velocity(TAmean),and time-maximal mean velocity(TAmax).Patients with a Hollmen score≥2 were defined as successful SNB block 45 minutes after block.The patients were divided into SNB success group(group S,Hollmen score≥2 points)and SNB failure group(group F,Hollmen score<2 points).Receiver operating characteristic(ROC)curves of percent increase in regional hemodynamic parameters 10 minutes after SNB completion were constructed to predict the effect of SNB.Results Fifty-nine patients(88.1%)were successfully blocked in this study.The ROC curve of the rate of change of regional hemodynamic parameters 10 minutes after SNB was constructed.The AUC of PSV in the anterior tibial artery region was 0.893(95%CI 0.780-1.000),the cutoff value was 19.22%,the sensitivity was 86.7%,and the specificity was 90.0%.The AUC of EDV was 0.748(95%CI 0.615-0.880),the cutoff value was 48.65%,the sensitivity was 75.0%,and the specificity was 72.7%.The AUC of TAmean was 0.827(95%CI 0.728-0.925),the cutoff value was 72.88%,the sensitivity was 68.3%,and the specificity was 100%.The AUC of TAmax was 0.850(95%CI 0.763-0.937),the cutoff value was 82.12%,the sensitivity was 70.5%,and the specificity was 100%.The AUC of PSV in the posterior tibial artery region was 0.880(95%CI 0.790-0.970),the cutoff value was 35.9%,the sensitivity was 68.3%,and the specificity was 100%.The AUC of EDV was 0.786(95%CI 0.659-0.913),the cutoff value was 49.8%,the sensitivity was 81.7%,and the specificity was 70.0%.The AUC of TAmean was 0.804(95%CI 0.701-0.908),the cutoff value was 53.3%,the sensitivity was 68.3%,and the specificity was 90.9%.The AUC of TAmax was 0.852(95%CI 0.758-0.947),the cutoff value was 45.9%,the sensitivity was 76.7%,and the specificity was 90.0%.Conclusion Regional hemodynamic parameters can be used as good indicators for clinicians to early predict the effect of SNB.