發(fā)布時(shí)間：2018-04-18 08:33

  本文選題：喉肌電圖 + 喉上神經(jīng)阻滯��； 參考：《臨床麻醉學(xué)雜志》2015年08期

【摘要】：目的通過(guò)觀察喉肌電圖中環(huán)甲肌肌電募集相對(duì)喉上神經(jīng)阻滯效果評(píng)估的準(zhǔn)確性,探討環(huán)甲肌肌電圖對(duì)清醒氣管插管評(píng)估的準(zhǔn)確性。方法困難氣道患者14例,麻醉誘導(dǎo)前在舌骨大角平面行喉上神經(jīng)阻滯,雙側(cè)各注入1%利多卡因2ml,口咽部及經(jīng)環(huán)甲膜穿刺氣管內(nèi)1%丁卡因表面麻醉各2ml,后行纖維支氣管鏡清醒氣管插管。喉上神經(jīng)阻滯效果以臨床診斷作判別標(biāo)準(zhǔn),同時(shí)肌電圖電極經(jīng)皮膚檢測(cè)喉上神經(jīng)支配的環(huán)甲肌肌電募集相。以臨床診斷喉上神經(jīng)阻滯效果佳(陽(yáng)性)作為評(píng)判標(biāo)準(zhǔn),通過(guò)受試者工作特征曲線(ROC曲線)分析環(huán)甲肌肌電募集相對(duì)喉上神經(jīng)阻滯效果反應(yīng)的敏感性和特異性,尋找診斷臨界值(cutoff點(diǎn));采用Spearman檢驗(yàn)分析募集相與阻滯效果的相關(guān)性。結(jié)果環(huán)甲肌肌電募集相對(duì)喉上神經(jīng)阻滯效果反應(yīng)的ROC曲線下面積(AUC)為:0.927(95%CI 0.799~1.000);當(dāng)肌電募集為減弱"++"相時(shí),敏感度與特異度之和值最大,其敏感性為75.0%,特異性為91.7%;Spearman相關(guān)系數(shù)r=0.659(95%CI 0.525~0.779,P=0.002)。結(jié)論應(yīng)用環(huán)甲肌肌電募集模式對(duì)喉上神經(jīng)阻滯術(shù)效果進(jìn)行評(píng)估有很高的準(zhǔn)確性。當(dāng)環(huán)甲肌肌電募集減弱為"++"相或以下時(shí),相應(yīng)側(cè)的聲門(mén)上黏膜感覺(jué)消失,神經(jīng)阻滯效果佳,可作為判別清醒氣管插管時(shí)機(jī)的指標(biāo)。
[Abstract]:Objective to observe the accuracy of laryngeal electromyography (LEMG) in evaluating the effect of superior laryngeal nerve block (SCB) on artesian myoelectric recruitment, and to explore the accuracy of RMG in evaluating lucid tracheal intubation.Methods 14 patients with difficult airway were treated with superior laryngeal nerve block at the level of the large angle of hyoid before anesthesia induction.Bilateral injection of 1% lidocaine 2 ml, oropharynx and 1% tetracaine surface anesthesia 2 ml, followed by fiberoptic bronchoscope lucid tracheal intubation.The effect of supralaryngeal nerve block was based on clinical diagnosis, and electromyography electrode was used to detect the electrical recruitment phase of the superior laryngeal nerve.The sensitivity and specificity of the response to the superior laryngeal nerve block were analyzed by using the operating characteristic curve (ROC curve) of the subjects and the sensitivity and specificity of the response to the superior laryngeal nerve block by using the clinical diagnosis of superior laryngeal nerve block.Spearman test was used to analyze the correlation between recruitment phase and block effect.Results the area under the ROC curve of the response to the superior laryngeal nerve block was: 1: 0.92795 CI 0.7991.0000.When the EMG recruitment was weakened, the sum of sensitivity and specificity was the highest, the sensitivity was 75.0 and the specificity was 91.7 Spearman correlation coefficient (r=0.659(95%CI 0.5250.779P0. 002).Conclusion it is accurate to evaluate the effect of superior laryngeal nerve block by ring myoelectric recruitment.When the myoelectric recruitment decreased to "" phase or below, the corresponding supraglottic mucosa sensation disappeared and the nerve block effect was good, which could be used as an index to judge the time of lucid tracheal intubation.
【作者單位】： 海南醫(yī)學(xué)院附屬醫(yī)院麻醉科;海南省人民醫(yī)院麻醉科;
【分類號(hào)】：R614

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