Diagnostic value of diaphragm thickness index in diaphragmatic paralysis caused by interscalene brachial plexus block
Objective To evaluate the diagnostic value of the diaphragm thickening index(DTI)in diaphragmatic paralysis caused by interscalene brachial plexus block.Methods Fifty-one patients,27 males and 24 females,aged 18-64 years,BMI 18-30 kg/m2,ASA physical status Ⅰ or Ⅱ were selected for internal fixation or internal fixation of mid-humerus and radius fractures.All the patients received ultra-sound-guided interscalene brachial plexus block with 0.5％ropivacaine 20 ml.The patients were divided into two groups:the paralytic group(n=11,DE ≥25％)and the non-paralytic group(n=40,DE＜25％),based on the degree of diaphragm excursion(DE)during strenuous breathing.DE,end-inspiratory diaphragm thickness(DTei),end-expiratory diaphragm thickness(DTee),forced vital capacity(FVC),forced expiratory volume in one second(FEV1),SpO2,sensory and motor block time,and recovery time were recorded before and 15 minutes after block,as well as fentanyl dosage.Adverse reactions such as nau-sea,vomiting,hoarse,headache,Hornner syndrome,hypotension,and dyspnea occurred within 24 hours of administration were recorded.Receiver operating characteristic(ROC)curves were drawn to analyze the area under the curve(AUC)and 95％confidence interval(CI),threshold,sensitivity and specificity of DTI and FVC declines in the diagnosis of brachial plexus block induced acute diaphragmatic paralysis.Results There was no significant difference in DE,DTI,FVC,FEV1,and SpO2 between the two groups.Compared with the non-paralytic group,DE and DTI of the paralytic group were significantly decreased(P＜0.05),the decrease range of DE and FVC was significantly increased(P＜0.05),and the inci-dence of dyspnea was significantly increased(P＜0.05).There was no significant difference in fentanyl dosage and other adverse reactions between the two groups.The AUC of DTI for the diagnosis of acute dia-phragmatic paralysis after retardation was 0.973(95％CI 0.927-1.000),while the threshold was 1.2,the sensitivity was 100％,and the specificity was 95％.The AUC for diagnosis of acute diaphragmatic paralysis was 0.697(95％CI 0.534-0.860),while the threshold was 10％,the sensitivity was 100％,and the spe-cificity was 38％.Conclusion Compared with forced vital capacity,diaphragmatic thickness index has a better diagnostic value in the diagnosis of acute diaphragmatic paralysis caused by brachial plexus block,and does not require preoperative baseline measurement.
Diaphragm thickening indexDiaphragm excursionForced vital capacityForced ex-piratory volume in one secondDiaphragmatic paralysisBrachial plexus block
万方数据
维普
