小儿腋路臂丛神经的超声解剖及应用研究

Ultrasonic anatomical characteristics of axillary brachial plexus nerve in children and its clinical application

目的探讨小儿腋路臂丛神经的超声解剖学特点及超声引导下腋路臂丛神经阻滞的可行性和安全性。方法选择行手及前臂手术患儿100例,采用随机数字表法将患儿分为观察组和对照组各50例,观察组应用超声可视化技术明确腋路臂丛神经的解剖结构,并在超声引导神经刺激仪定位下行腋路臂丛神经阻滞;对照组在单纯神经刺激仪定位下行腋路臂丛神经阻滞。两组用药均为0.2%罗哌卡因。观察两组患儿的麻醉效果、止血带反应、腋鞘血肿和神经损伤发生数。结果观察组有2例患儿在腋窝处未找到肌皮神经,将探头向远端探测,则可以看到支配喙肱肌的肌皮神经。两组患儿手术时间比较差异无统计学意义(P>0.05)。观察组患儿麻醉优良率明显高于对照组,差异有统计学意义(P<0.05);止血带反应数和腋鞘血肿发生数均低于对照组,但差异均无统计学意义(均P>0.05)。结论超声能清晰显示小儿腋路臂丛神经的正常解剖及解剖变异,并引导神经刺激仪穿刺针到达靶神经周围,较单纯神经刺激仪定位下操作安全可靠,优势明显,值得临床推广应用。

Objective To explore the ultrasonic anatomical characteristics of axillary brachial plexus nerves in children and its clinical application. Methods One hundred children undergoing selective hand or forearm operation were randomly divided into two groups with 50 in each. In study group the ultrasonic visualization technology was applied for anatomical structure of axillary brachial plexus, and the axillary brachial plexus nerves block was performed under ultrasound guidance and nerve stimulator positioning, while in control group only the conventional nerve stimulator positioning was applied. In both groups 0.2% ropivacaine was administrated for axillary brachial plexus nerve block anesthesia. The anesthesia effect, tourniquet reaction, axillary sheath hematoma and nerve damage were observed in compared between two groups. Results In 2 cases of study group the musculocutaneous nerves were not detected in axilla, when sliding probe to the remote position, the nerves dominated the beak brachial muscle were found. The anesthesia effect in study group was significantly higher than that in control group （P〈O.05）. There were no significant differences in the incidence of tourniquet reaction and axillary sheath hematoma, and operation time between two groups （all P 〉0.05）. Conclusion Ultrasound-guided nerve stimulator can be applied in axilary brachial plexus block anesthesia for young children with safety and reliability.