区域血液动力学变量和灌注指数在评估坐骨神经阻滞中的应用：一项前瞻性观察性试验。

Regional haemodynamic variables and perfusion index in the evaluation of sciatic nerve block: a prospective observational trial.

机构信息

Department of Anesthesiology, Ningbo Huamei Hospital University of Chinese Academy of Sciences, Ningbo, China.

Department of Anesthesiology, The Affiliated People's Hospital of Ningbo University, Ningbo, China.

出版信息

BMJ Open. 2022 May 2;12(5):e057283. doi: 10.1136/bmjopen-2021-057283.

DOI:10.1136/bmjopen-2021-057283

PMID:35501099

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9062819/

Abstract

OBJECTIVE

We determined whether regional haemodynamics and perfusion index (PI) could be reliable indicators of a successful sciatic nerve block (SNB).

DESIGN

Prospective observational trial.

SETTING

A tertiary teaching hospital in China from April 2020 to August 2020.

PARTICIPANTS

We assessed 79 patients for eligibility to participate in this study. Nine patients were excluded for not meeting our inclusion criteria, and three patients were excluded due to missing measurements at all time points.

INTERVENTIONS

The patients underwent SNB. Pulsed-wave Doppler and PI measurements were performed.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome measure was the diagnostic power of regional haemodynamic change and PI to predict successful SNB. The secondary outcome measure was the effect of SNB on the regional haemodynamics and PI in the lower extremity.

RESULTS

We assessed 79 patients in this study and 67 patients available for the final analysis. The SNB was successful in 59 patients and failed in eight patients. There were no significant differences in demographic characteristics between the patients with successful and failed SNB. Starting from 10 min after SNB, the peak systolic velocity (PSV), end-diastolic velocity, time-averaged maximum velocity and time-averaged mean velocity of the anterior tibial artery and posterior tibial artery of patients in the successful SNB group were significantly higher than those in the failed SNB group (p<0.05). The PSV percentage increase at 10 min after SNB has great potential to predict the block success. The area under the receiver operating characteristic curve (AUC) values were 0.893 (95% CI 0.7809 to 1.000) and 0.880 (95% CI 0.7901 to 0.9699). The corresponding cut-off values were 19.22 and 35.88, respectively. The PI increased during 5-45 min intervals in patients with successful SNB. The AUC for the PI percentage increases at 10 min after SNB was 0.853 (95% CI 0.7035 to 1.000), with a cut-off value of 93.09.

CONCLUSION

The regional haemodynamic variables, PSV and PI in particular, can be used as alternative indicators for clinicians to evaluate the success of SNB objectively and early.

TRIAL REGISTRATION NUMBER

ChiCTR2000030772.

摘要

目的

我们旨在确定局部血流动力学和灌注指数（PI）是否可以作为坐骨神经阻滞（SNB）成功的可靠指标。

设计

前瞻性观察性试验。

地点

中国一家三级教学医院，时间为 2020 年 4 月至 2020 年 8 月。

参与者

我们评估了 79 名符合条件的患者参与本研究。有 9 名患者因不符合纳入标准而被排除，有 3 名患者因所有时间点均未测量而被排除。

干预措施

患者接受 SNB。进行脉冲波多普勒和 PI 测量。

主要和次要结局测量

主要结局测量指标是局部血流动力学变化和 PI 预测 SNB 成功的诊断能力。次要结局测量指标是 SNB 对下肢局部血流动力学和 PI 的影响。

结果

本研究共评估了 79 名患者，其中 67 名患者可进行最终分析。59 名患者的 SNB 成功，8 名患者的 SNB 失败。SNB 成功组和失败组患者的人口统计学特征无显著差异。从 SNB 后 10 分钟开始，成功 SNB 组患者的胫前动脉和胫后动脉的收缩期峰值速度（PSV）、舒张末期速度、平均时间最大速度和平均时间平均速度均显著高于失败 SNB 组（p<0.05）。SNB 后 10 分钟 PSV 百分比增加具有预测阻滞成功的巨大潜力。受试者工作特征曲线（ROC）曲线下面积（AUC）值分别为 0.893（95%CI 0.7809 至 1.000）和 0.880（95%CI 0.7901 至 0.9699）。相应的截断值分别为 19.22 和 35.88。成功 SNB 患者的 PI 在 5-45 分钟间隔内增加。SNB 后 10 分钟 PI 百分比增加的 AUC 为 0.853（95%CI 0.7035 至 1.000），截断值为 93.09。