未经批准:这个前景,双盲,随机研究评估(1)膈肌复合动作电位(CMAP),膈肌偏移,和锁骨上臂丛神经阻滞(SCBPB)后的肺功能,以及(2)评估了diaphragm肌CMAP作为diaphragm肌强度评估证明的肺功能对膈肌麻痹的诊断功效。
UNASSIGNED:86例患者被安排在右上肢骨折愈合后移除硬件,这些患者以1:1的比例随机分为两组:A组(膈肌偏移),或B组(肺功能)。膈神经传导研究(PNCSs),隔膜的M型超声检查,在SCBPB之前和之后30分钟进行肺功能检查(PFTs)。PNCS用于确定隔膜CMAP的潜伏期和振幅。在仰卧位的患者中,使用低频探头在锁骨中线的肋下空间上对the肌进行超声检查。在安静呼吸和深呼吸期间测量膈肌偏移。肺功能,即,强迫肺活量(FVC),FVC的预测值,和第一秒的强制呼气流量(FEV1),用肺活量测定法测量。受试者工作特征(ROC)曲线分析用于评估肺功能对膈肌麻痹的诊断功效,其中膈肌CMAP是对膈肌强度的评估。
UNASSIGNED:当表示为基线值的百分比时,在安静呼吸(r=0.70,p<0.01)和深呼吸(r=0.63,p<0.01)期间,隔膜CMAP幅度的降低与隔膜偏移的降低之间存在显着关联。隔膜CMAP振幅的降低与FVC的降低之间存在显着关联(r=0.67,p<0.01),FVC%(r=0.67,p<0.01),和FEV1(r=0.62,p<0.01),以基线值的百分比表示。FVC的ROC曲线下面积为0.86。与阻滞前预测的膈肌麻痹(由膈肌CMAP确定)相比,FVC降低>8.4%,敏感性和特异性分别为79.2和100%,分别。
UNASSIGNED:SCBPB术后膈肌CMAP振幅的相对降低与膈肌偏移和肺功能的相对降低相关。FVC有潜力作为一个有用的诊断指标,由隔膜CMAP证明,在SCBPB之后。这些数据将diaphragm肌CMAP确立为SCBPB后diaphragm肌麻痹的直接客观指标。
UNASSIGNED: This prospective, double-blind, randomized study assessed (1) the associations between diaphragm compound muscle action potential (CMAP), hemidiaphragmatic excursion, and pulmonary function after supraclavicular brachial plexus block (SCBPB) and (2) diagnostic efficacy of pulmonary function for hemidiaphragmatic paralysis evidenced by diaphragm CMAP as an assessment of diaphragm strength was evaluated.
UNASSIGNED: Eighty-six patients were scheduled for the removal of hardware after healing of a right upper limb fracture distal to the shoulder who were randomly assigned in a 1:1 ratio to two groups: Group A (diaphragmatic excursion), or Group B (pulmonary function). Phrenic nerve conduction studies (PNCSs), M-mode ultrasonography of the diaphragm, and pulmonary function tests (PFTs) were performed before and 30 min after SCBPB. PNCSs were used to determine the latency and amplitude of diaphragm CMAP. Ultrasonography of the diaphragm was performed with patients in a supine position using a low-frequency probe over the subcostal space at the midclavicular line. The diaphragmatic excursion was measured during quiet breathing and deep breathing. Pulmonary function, i.e., forced vital capacity (FVC), predicted value of FVC, and forced expiratory flow in the first second (FEV1), was measured with spirometry. Receiver Operating Characteristic (ROC) curve analysis was used to assess the diagnostic efficacy of pulmonary function for hemidiaphragmatic paralysis evidenced by diaphragm CMAP as an assessment of diaphragm strength.
UNASSIGNED: There were significant associations between the reduction in amplitude of diaphragm CMAP and reductions in diaphragmatic excursion during quiet breathing (r = 0.70, p < 0.01) and deep breathing (r = 0.63, p < 0.01) when expressed as a percentage of baseline values. There were significant associations between the reduction in amplitude of diaphragm CMAP and reductions in FVC (r = 0.67, p < 0.01), FVC% (r = 0.67, p < 0.01), and FEV1 (r = 0.62, p < 0.01), when expressed as percentage of baseline values. The area under the ROC curve for FVC was 0.86. A decrease of >8.4% in FVC compared to pre-block predicted hemidiaphragmatic paralysis (determined by diaphragm CMAP) with sensitivity and specificity of 79.2 and 100%, respectively.
UNASSIGNED: The relative reduction in diaphragm CMAP amplitude after SCBPB was correlated with relative reductions in diaphragmatic excursion and pulmonary function. FVC has potential as a useful diagnostic indicator of hemidiaphragmatic paralysis, evidenced by diaphragm CMAP, after SCBPB. These data establish diaphragm CMAP as a direct and objective index of diaphragmatic paralysis after SCBPB.