Trainee anaesthetist diagnosis of intraneural injection-a study comparing B-mode ultrasound with the fusion of B-mode and elastography in the soft embalmed Thiel cadaver model.
Trainee anaesthetist diagnosis of intraneural injection-a study comparing B-mode ultrasound with the fusion of B-mode and elastography in the soft embalmed Thiel cadaver model.
复制标题
见习麻醉师对神经内注射的诊断——一项在软防腐 Thiel 尸体模型中比较 B 型超声与 B 型和弹性成像融合的研究。
DOI：
10.1093/bja/aew337
复制
发表时间：
2016
影响因子：
9.8
通讯作者：
G. McLeod
中科院分区：
文献类型：
--
作者：
S. Munirama;K. Zealley;A. Schwab;M. Columb;G. Corner;R. Eisma;G. McLeod
背景
受训麻醉师超声引导神经阻滞期间神经内注射的发生率在专家的16%和受训者的35%之间变化。我们假设，弹性成像，一种基于超声的技术，提供彩色图像的组织应变，有可能提高实习生诊断神经内注射在UGRA期间，当与B型超声整合到一个单一的图像。
方法
我们记录了40个正中神经阻滞随机分配到0.25毫升，0.5毫升，1毫升体积的五个网站，在两个软防腐尸体的双臂，使用专用的B型超声和弹性成像换能器。我们编写了融合弹性成像和B模式视频的软件，然后询问20名实习麻醉师，当看到B模式视频、相邻B模式和弹性成像视频、融合弹性成像视频或重复B模式超声视频时，注射是神经内还是神经外。
结果
与B超相比，融合弹性成像提高了神经内注射的诊断，诊断比值比（DOR）（95%CI）21.7（14.5 - 33.3）vs DOR 7.4（5.2 - 10.6），P < 0.001。与神经内注射相比，神经内注射在融合弹性成像上被识别为明显的、更明亮的半透明图像，几何比为0.33（95%CI：0.16 - 0.49）P < 0.001。融合弹性成像与更高的受训者诊断信心相关，OR（95%CI）1.89（1.69 - 2.11），P < 0.001，可靠性提高，Kappa 0.60（0.55 - 0.66）。
结论
融合弹性成像提高了实习麻醉师诊断神经内注射的准确性、可靠性和信心。
BACKGROUND
The incidence of intraneural injection during trainee anaesthetist ultrasound guided nerve block varies between 16% in experts and up to 35% in trainees. We hypothesized that elastography, an ultrasound-based technology that presents colour images of tissue strain, had the potential to improve trainee diagnosis of intraneural injection during UGRA, when integrated with B-Mode ultrasound onto a single image.
METHODS
We recorded 40 median nerve blocks randomly allocated to 0.25 ml, 0.5 ml, 1 ml volumes to five sites, on both arms of two soft embalmed cadavers, using a dedicated B-Mode ultrasound and elastography transducer. We wrote software to fuse elastogram and B-Mode videos, then asked 20 trainee anaesthetists whether injection was intraneural or extraneural when seeing B-Mode videos, adjacent B-Mode and elastogram videos, fusion elastography videos or repeated B-Mode ultrasound videos.
RESULTS
Fusion elastography improved the diagnosis of intraneural injection compared with B-Mode ultrasound, Diagnostic Odds Ratio (DOR) (95%CI) 21.7 (14.5 - 33.3) vs DOR 7.4 (5.2 - 10.6), P < 0.001. Compared with extraneural injection, intraneural injection was identified on fusion elastography as a distinct, brighter translucent image, geometric ratio 0.33 (95%CI: 0.16 - 0.49) P < 0.001. Fusion elastography was associated with greater trainee diagnostic confidence, OR (95%CI) 1.89 (1.69 - 2.11), P < 0.001, and an improvement in reliability, Kappa 0.60 (0.55 - 0.66).
CONCLUSIONS
Fusion elastography improved the accuracy, reliability and confidence of trainee anaesthetist diagnosis of intraneural injection.