超声引导在小儿肌间沟臂丛神经阻滞中的应用研究

Application value of ultrasound-guided intermuscular groove brachial plexus block in children

目的探讨小儿肌间沟臂丛神经超声解剖学特点及超声引导在小儿肌间沟臂丛神经阻滞中的临床应用价值。方法 75例拟行上肢手术患儿,应用超声检查肌间沟内臂丛神经的分布情况,观察其回声特点,测量神经干的直径及其距离皮肤的深度,并在超声引导下行肌间沟臂丛阻滞麻醉,Ⅰ组患儿21例,使用0.25%布比卡因1.0 ml/kg;Ⅱ组患儿54例,使用0.25%布比卡因0.5 ml/kg;两组总量均<20 ml。比较两组注药后各时点各神经阻滞情况。结果 75例小儿肌间沟臂丛神经超声检查均清晰显示,呈类圆形低回声,周边为强回声,边界清晰。上干支直径(1.61±0.20)mm,距离皮肤层深度(6.50±1.00)mm;中干支直径(1.73±0.17)mm,距离皮肤层深度(8.24±0.93)mm;下干支直径(1.78±0.26)mm,距离皮肤层深度(10.50±0.97)mm;Ⅰ、Ⅱ组超声引导下肌间沟臂丛阻滞麻醉有效率均达100%。结论臂丛神经超声解剖结构清晰,超声引导下小儿肌间沟臂丛神经阻滞可减少麻醉药剂量,臂丛阻滞安全可行。

Objective To investigate the ultrasonic anatomy characteristics of pediatric intermuscular groove brachial plexus nerve and the clinical application value of ultrasound guidance in intermuscular groove brachial plexus block. Methods Seventy-five pediatric patients prepared for upper limb operation were enrolled,high-frequency ultrasound was applied to observe the distribution and echo of intermuscular groove brachial plexus nerve, the neural stem diameter and the depth from the skin were measured. Block of the braehial plexus was guided by ultrasound. In group Ⅰ （21 cases）, 0.25% bupivacaine was used with the dose of 1.0 ml/kg, in group Ⅱ（54 cases）, 0.25% bupivacaine was used with the dose of 0.5 ml/kg, the total dose was 〈20 ml. The efficiency of nerve block was compared between the two groups. Results The intermuscular groove brachial plexus was clearly displayed in 75 cases. It showed round bypoechoic structure surrounded by strong echo with clear boundary. The upper stem diameter was （1.61±0.20） mm, （6.50±1.00）mm depth from the skin , the middle stem diameter was （ 1.73±0.17 ）mm, （ 8.24±0.93 ）mm depth from the skin, the inferior stem diameter was （ 1.78±0.26 ）mm, （ 10.50±0.97 ）mm depth from the skin. The efficiency of ultrasound-guided intermuscular groove brachial plexus block in two groups was 100% respectively. Conclusion Ultrasound anatomical structure of the brachial plexus is clear. Braehial plexus block guided by ultrasound can reduce drug dose, which is safe and feasible.