热变色指甲油可作为预测锁骨下臂丛神经阻滞成功的新指标：前瞻性队列研究
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Thermochromic nail polish as a novel indicator to predict infraclavicular brachial plexus block success A prospective cohort study
背景与目的
周围神经阻滞后测量皮肤温度可作为一种简便、客观的方法来预测阻滞成功与否。热变色指甲油是很受欢迎的化妆品，特别是在年轻女性中。指甲油的颜色变化是基于温度变化时的热变色反应。本研究旨在验证锁骨下臂丛神经阻滞(IBPB)的成功与否可通过热色指甲油的颜色变化来预测这一假设，而这种颜色变化取决于皮肤温度的变化。
方 法
我们共收集了50例施行IBPB前臂、手腕或手部手术的患者。所有患者在阻滞前均于双手指甲上涂抹热变色指甲油，并分别于涂抹完成后即刻和神经阻滞后30min拍摄双手指甲油颜色情况。观察者对每位患者的数码照片进行评估。为了评价指甲油颜色变化对预测IBPB成功的有效性，我们对其敏感性、特异性、阳性预测值、阴性预测值以及阳性和阴性似然比进行了评估。
结 果
热变色指甲油颜色变化预测IBPB成功的阳性预测值为96%（95%CI：90~98）,灵敏度为94%(95%CI：87~97）。评估观察者间一致性的Fleisskappa值基本一致(0.76，95%CI:0.59~ 0.93)。
结 论
本研究表明，热变色指甲油的颜色变化是预测IBPB阻滞成功的一个有效且可靠的指标。
原始文献摘要
KavakliAS,EnginarF,Arslan U, et,al.Thermochromic nail polish as a novel indicator to predict infraclavicular brachial plexus block success A prospectivecohort study.[J]. Eur J Anaesthesiol 2019Dec;36(12)DOI:10.1097/EJA.00000000000 01091
BACKGROUND Skin temperature measurements after peripheral nerve block can be used as an easy and objective method to help predict block success. Thermochromic nail polishes are popular cosmetic products especially among young women. The colour change of nail polish is based on a thermochromic reaction as the temperature changes.
OBJECTIVE The aim of this study was to test the hypothesis that the success of infraclavicular brachial plexus blocks(IBPBs) can be predicted by the colour change in thermo-chromic nail polish, which depends on skin temperature changes.
DESIGN A prospective cohort study.
SETTING Training and research hospital from December 2018 to March 2019.
PATIENTS A total of 50 patients who received IBPB for forearm, wrist or hand surgery were included.
MAIN OUTCOME MEASURES Thermochromic nail polish was applied to the nails of both hands of all patients before the block. Reaction of the nail polish in both hands was photographed immediately after application of nail polish and at 30 min after performing the block. The digital photographs of each patient were evaluated by observers. To evaluate the validity of the colour change in nail polish in predicting a successful IBPB,sensitivity, specificity,positive and negative predictive values and positive and negative likelihood ratioswere estimated.
RESULTS The positive predictive value for colour change in thermochromic nail polish predicting a successful IBPB was 96% [95% confidence interval (CI) 90 to 98] and sensitivity was 94% (95% CI 87 to 97). Fleiss kappa value showed substantial agreement (0.76; 95% CI 0.59 to 0.93) in the assessment of interobserver agreement.
CONCLUSION The current study demonstrates that the colour change in thermochromic nail polish is a valid and reliable indicator for the prediction of block success.
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贵州医科大学高鸿教授课题组
翻译：牛振瑛 编辑：冯玉蓉 审校：王贵龙