灌注指数比值和舒张末期速度比值在评估肌间沟臂丛神经阻滞疗效中的有效性：一项前瞻性观察研究。

Effectiveness of Perfusion Index ratio and End-Diastolic Velocity ratio in evaluating the efficacy of Interscalene Brachial Plexus Block: a prospective observational study.

作者信息

Hu Li, Sun Jintao, Zhang Bin, Ye Xiaoyan, Lu Jian, Zhu Zhipeng, Zhou Hongmei

机构信息

Department of Anesthesiology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China.

Key Laboratory of Basic Research and Clinical Transformation of Perioperative Precision Anesthesia, Jiaxing, China.

出版信息

Front Med (Lausanne). 2025 Apr 3;12:1571171. doi: 10.3389/fmed.2025.1571171. eCollection 2025.

DOI:10.3389/fmed.2025.1571171

PMID:40248077

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12004410/

Abstract

OBJECTIVE

There is a lack of reliable indicators for evaluating the success of ultrasound-guided Interscalene Brachial Plexus Block (ISBPB). This study investigates the effectiveness of Perfusion Index (PI) ratio and End-Diastolic Velocity (EDV) ratio for early assessment of ISBPB effects.

METHODS

Eighty-nine patients, aged 18-65 with BMI 18-24 kg/m and ASA grade I or II, underwent elective unilateral shoulder arthroscopic surgery. They received ultrasound-guided ISBPB with 15 mL local anesthetic (10 mL ropivacaine, 5 mL lidocaine). Patients were categorized into successful and failure groups based on needle test results after 30 min. PI and EDV of the brachial artery were recorded at baseline and at 5, 10, 15, 20, 25, and 30 min post-block. PI and EDV ratios were calculated by dividing values at each time by baseline. ROC curves were plotted at 5 and 10 min, and AUROC with 95% CI was calculated to assess block efficacy.

RESULTS

Of 89 patients, 3 were excluded due to data loss and 2 withdrew, leaving 84 patients. Of these, 70 (83.3%) had successful blocks. In the successful group, both PI and EDV ratios on the blocked side significantly increased 5 min after the procedure. The PI ratio at 5 min had an AUROC of 0.894 (95% CI: 0.816-0.972), with a threshold of 1.22, sensitivity of 84.3%, and specificity of 85.7%. The EDV ratio had an AUROC of 0.706 (95% CI: 0.553-0.860), with a threshold of 1.32, sensitivity of 92.9%, and specificity of 50%. At 10 min, the PI ratio for assessing ISBPB impact had an AUROC of 0.901 (95% CI: 0.828-0.974), with a threshold of 1.4, sensitivity of 74.3%, and specificity of 92.9%. The AUROC for the EDV ratio was 0.799 (95% CI: 0.6788-0.921) with a threshold of 1.54, sensitivity of 92.9%, and specificity of 57.1%. The PI ratio at 5 min had a significantly higher AUROC than the EDV ratio, but no significant difference was found between PI ratios at 5 and 10 min.

CONCLUSION

Both PI ratio and EDV ratio assess ISBPB efficacy. The PI ratio provides a more precise evaluation, with optimal assessment at 5 min post-procedure.

CLINICAL TRIAL REGISTRATION

Chinese Clinical Trial Registry: ChiCTR2200066874.

摘要

目的

缺乏评估超声引导下肌间沟臂丛神经阻滞（ISBPB）成功与否的可靠指标。本研究探讨灌注指数（PI）比值和舒张末期速度（EDV）比值在早期评估ISBPB效果方面的有效性。

方法

89例年龄在18 - 65岁、BMI为18 - 24 kg/m²且ASA分级为I或II级的患者，接受择期单侧肩关节镜手术。他们接受了超声引导下的ISBPB，使用15 mL局部麻醉剂（10 mL罗哌卡因，5 mL利多卡因）。根据30分钟后的针刺试验结果，将患者分为成功组和失败组。在阻滞前基线以及阻滞后5、10、15、20、25和30分钟记录肱动脉的PI和EDV。PI和EDV比值通过将各时间点的值除以基线值来计算。在5分钟和10分钟绘制ROC曲线，并计算95%CI的AUROC以评估阻滞效果。

结果

89例患者中，3例因数据丢失被排除，2例退出，最终纳入84例患者。其中，70例（83.3%）阻滞成功。在成功组中，阻滞后5分钟时，阻滞侧的PI和EDV比值均显著升高。5分钟时PI比值的AUROC为0.894（95%CI：0.816 - 0.972），阈值为1.22，敏感性为84.3%，特异性为85.7%。EDV比值的AUROC为0.706（95%CI：0.553 - 0.860），阈值为1.32，敏感性为92.9%，特异性为50%。在10分钟时，评估ISBPB效果的PI比值的AUROC为0.901（95%CI：0.828 - 0.974），阈值为1.4，敏感性为74.3%，特异性为92.9%。EDV比值的AUROC为0.799（95%CI：0.6788 - 0.921），阈值为1.54，敏感性为92.9%，特异性为57.1%。5分钟时的PI比值的AUROC显著高于EDV比值，但5分钟和10分钟时的PI比值之间未发现显著差异。