改良的臂丛阻滞麻醉

doi:10.16098/j.issn.0529-1356.2020.01.011

摘要/Abstract

摘要：

目的探讨解剖学对臂丛神经阻滞麻醉的影响，为临床研究及应用提供参考依据。方法选取20具尸体，应用经改良的喙突下臂丛神经阻滞法入路定位，进行垂直穿刺，神经阻滞点采用蓝色染料标记，同时对神经集中部位与标记点进行解剖暴露，探查神经集中点和体表标志之间的解剖关系。结果左侧集中部位上缘到锁骨下缘中点、胸锁关节下缘、肩峰及喙突下缘的距离分别为（3.62±0.24）cm、（10.39±0.25）cm、（6.67±0.18）cm及（2.80±0.19）cm；右侧集中部位上缘到锁骨下缘中点、胸锁关节下缘、肩峰及喙突下缘的距离分别为（4.24±0.27）cm、（11.10±0.28）cm、（6.35±0.19）cm及（3.03±0.15）cm。结论局部解剖学的应用提高臂丛神经阻滞的准确性，从而可提高臂丛神经阻滞麻醉的效果，为临床研究及应用提供参考依据。

关键词: 解剖学, 臂丛神经阻滞麻醉, 改良法, 喙突下, 神经阻滞定位, 人

Abstract:

Objective To analyze the influence of topographic anatomy on brachial plexus block anesthesia, and to provide reference for clinical research and application. Methods Total of 20 cadavers were selected and located through the modified method of inferior brachial plexus block of the coracoid process. The nerve blocking points were marked with blue dye, and the nerve concentration sites and marking points were dissected and exposed at the same time. The anatomical relationship between nerve concentration points and body surface markers were explored. Results The distances from the upper margin of the left centralization to the midpoint of the subclavian border, the inferior margin of the sternoclavicular joint, the shoulder peak and the inferior edge of the coracoid process were (3.62±0.24) cm, (10.39±0.25) cm, (6.67±0.18) cm and (2.80±0.19) cm, respectively. The distances from the upper edge of the right centralization to the midpoint of the subclavian border, the inferior margin of the sternoclavicular joint, the shoulder peak and the inferior edge of the coracoid process were (4.24±0.27) cm, (11.10±0.28) cm, (6.35±0.19) cm and (3.03±0.15) cm, respectively. Conclusion The application of anatomy improves the accuracy of brachial plexus block, thus improves the effect of brachial plexus block anesthesia, and provides a powerful reference for clinical research and application.

Key words: Anatomy, Brachial plexus block anesthesia, Modified method, Subcoracoid process, Location of nerve block, Human

中图分类号:

R614.4

刘张玉李映云. 改良的臂丛阻滞麻醉[J]. 解剖学报, 2020, 51(1): 62-65.

LIU Zhang-yu LI Ying-yun. Modified braclial plexus block anesthesia[J]. Acta Anatomica Sinica, 2020, 51(1): 62-65.

参考文献

［1］ Wilmore DW, Kehlet H. Management of patients in fast track surgery ［J］.BMJ,2001，322(7284):473-476. 

［2］ Ren YH, Xu ZhY，Tu LL，et al. Morphological observation of fascial sheath of the sciatic nerve［J］. Acta Anatomica Sinica,2014,45(3):369-374.（in Chinese）

任彦红，徐朝阳，涂丽莉, 等.坐骨神经鞘膜的形态学观察［J］.解剖学报，2014,45（3）:369-374.

［3］ Xiao YJ, Zhang LM, Gao Y. Study of applied anatomy of modified subcoracoid brachial plexus block anesthesia ［J］. China Medicine and Pharmacy, 2018,8(19):40-44.（in Chinese）

肖奕君,张礼蔓,高云.改良法喙突下臂丛神经阻滞麻醉应用解剖学研究［J］.中国医药科学,2018,8(19):40-44.

［4］ Neal JM, Hebl JR, Gerancher JC，et al. Brachial plexus anesthesia: essentials of our current understanding ［J］. Reg Anesth Pain Med, 2002,27(4):402-428.

［5］ Upadhyaya Ⅴ, Upadhyaya DN, Kumar A, et al. MR neurography in traumatic brachial plexopathy［J］. Eur J Radiol, 2015, 84(5):927-932.

［6］ Cao ShM, Li ShSh, Lu RJ, et al. Comparision of the effects between the modified and classic coracoid approach in infraclavicular brachial plexus nerve block ［J］. Chinese Journal of Postgraduates of Medicine, 2014,37(32):38-40.（in Chinese）

曹淑梅，李莎莎，卢荣军，等. 改良喙突入路与经典喙突入路定位对锁骨下臂丛神经阻滞的影响对比［J］. 中国医师进修杂志,2014,37(32):38-40.

［7］ Chen WC, Tsai YH, Weng HH,et al. Value of enhancement technique in 3D-T2-STIR images of the brachial plexus［J］.J Comput Assist Tomogr, 2014, 38(3):335-339.

［8］ Mallouhi A, Marik W, Prayer D,et al. 3T MR tomography of the brachial plexus: structural and microstructural evaluation ［J］. Eur J Radiol, 2012,81(9):2231-2245.

［9］ Xie JQ, Zou Y, Xie JH. Applied anatomy of intermuscular groove brachial plexus block［J］. Guide of Science & Education, 2016, (8):158-159.（in Chinese）

谢军勤,邹艳,谢敬晖.肌间沟臂丛神经阻滞应用解剖浅探［J］.科教导刊(中旬刊),2016,(8):158-159.

［10］Lee JH, Lee SH. Comparison of clinical efficacy between interlaminar and transforaminal epidural injection in patients with axial pain due to cervical disc herniation ［J］. Medicine, 2016, 95(4):2568-2568.

［11］Xu ZhH, Wang LP. Anatomical characteristics and application value of ultrasoundguided block of brachial plexus in childre ［J］. China Medicine and Pharmacy，2016,6(14):111-114.（in Chinese）

徐祝红,王良萍.小儿肌间沟臂丛神经超声引导阻滞的解剖学特点及应用价值［J］.中国医药科学,2016,6(14):111-114.

［12］Bush K, Hillier S.Outcome of cervical radiculopathy treated with periradicular/epidural corticosteroid injections ［J］. Pain Med, 2015, 16 (12): 2414-2415.

［13］Wang LP, Si YH. Anatomic study of brachial plexus variation ［J］. Chinese Journal of Practical Nervous Diseases， 2015,18(18):82-83.(in Chinese)

王利萍,司运辉.臂丛神经变异的应用解剖学研究［J］.中国实用神经疾病杂志,2015,18(18):82-83.

［14］Cavusoglu M, C1l1z DS, Duran S，et al. Temporal bone MRI with 3D-FIESTA in the evaluation of facial and audiovestibular dysfunction ［J］. Diagn Interv Imaging, 2016,97(9):863-869.

[1]	刘晓丽许琳吴爱雪闻彩云李如画吴安婷陈黛茜陈成春. 多发性硬化和视神经脊髓炎的脑灰质结构分析 [J]. 解剖学报, 2024, 55(1): 17-24.
[2]	白贺滕野冯蕾孟海伟汤煜春刘树伟. 基于空间域与频域特征自适应融合和类间边界区域增强的三维海马分割[J]. 解剖学报, 2024, 55(1): 73-81.
[3]	尹诗琴杨思艺王锐涵游贵宣杨迎秋张磊. 基于CT平扫下胫腓联合腓骨切迹分型及其临床意义[J]. 解剖学报, 2024, 55(1): 82-87.
[4]	杨洋史君李琨马渊张少杰侯二飞王超群陈杰王星李志军 . 切除不同范围钩突后颈椎椎间盘的有限元分析[J]. 解剖学报, 2024, 55(1): 88-97.
[5]	孙雷王星宇谢水华. 老年骨质疏松性胸腰椎压缩性骨折患者PKP术后再发骨折的风险分析及列线图预测模型的构建[J]. 解剖学报, 2024, 55(1): 98-104.
[6]	刘丽平朱梦妮徐慧 . 白细胞介素6对脂多糖诱导所致类子痫前期大鼠有核红细胞的影响 [J]. 解剖学报, 2023, 54(6): 722-729.
[7]	赵卫明李晓余国营王改平常翠芳 . 丝氨酸肽酶抑制因子Kazal型1对肝癌细胞增殖的影响及其机制 [J]. 解剖学报, 2023, 54(6): 695-702.
[8]	袁硕赵安全黄其日麦拉图吴海贺徐永胜齐岩松包呼日查 . 基于下肢全长CT分析胫骨平台后倾角和胫骨扭转角与复发性髌骨脱位的相关性 [J]. 解剖学报, 2023, 54(6): 703-709.
[9]	韩毅蔡力冯枭 . 脊柱骨质疏松性压缩性骨折经皮穿刺椎体成形后骨水泥渗漏风险分析及列线图预测模型的构建 [J]. 解剖学报, 2023, 54(6): 710-715.
[10]	王子善张兴华徐飞宇克莉郑连斌程瑜 . 云南布朗族、德昂族、佤族营养体格指数、肥胖状况及其高血压预警 [J]. 解剖学报, 2023, 54(6): 730-737.
[11]	席焕久李文慧 . 关于人种问题的讨论[J]. 解剖学报, 2023, 54(5): 605-614.
[12]	杜大鹏孙玉张敏王汉琴 . 切应力通过Pim1/Akt调节人脐静脉内皮细胞内皮型一氧化氮合酶Ser633和Ser1177位点磷酸化[J]. 解剖学报, 2023, 54(5): 546-552.
[13]	周春辉谢胜强王姜婷兰晓娟张剑宁赵虎林. 多模态电磁导航辅助新鲜尸头经鼻内镜的颅底解剖测量[J]. 解剖学报, 2023, 54(5): 560-566.
[14]	刘颜静史勇红. 基于FPFH-PointNet的术中膝关节软骨表面点云自动提取[J]. 解剖学报, 2023, 54(5): 553-559.
[15]	白芃李玮钟铧王展飞. 藏族正常成人头颅正中矢状面幕上和幕下面积的磁共振成像测量[J]. 解剖学报, 2023, 54(5): 567-574.