锁骨上臂丛神经阻滞与膈肌麻痹的研究进展

Research Progress of Supraclavicular Brachial Plexus Blockand Diaphragm Paralysis

锁骨上臂丛神经阻滞(SCBPB)被称为上肢手术麻醉中的"脊麻",是上肢肩关节以下一种良好的麻醉和术后镇痛方法,但其不可避免地带来并发症,其中膈肌的麻痹越来越受关注。然而随着超声的应用,解剖结构、进针程度和局部麻醉药的扩散情况可视化,使SCBPB具有起效快、局部麻醉药用量少、持续时间长及阻滞成功率高等优点,但其所带来的并发症是不容忽视的,特别是因膈肌麻痹所致的呼吸窘迫。因此,在超声联合神经刺激仪的精确定位下,尽可能降低膈肌麻痹发生率成为未来的研究热点。

Supraclavicular brachial plexus block （SCBPB） is the spinal anesthesia for upper limb surgery, and is regarded as an effective method of anesthesia and analgesia for upper limb below the shoulder. However this method will inevitably bring about complications, especially diaphragmatic paralysis which has drawn more and more attention. However, the use of ultrasound, makes the anatomic structure, the degree of needle insertion and the spread of local anesthetics visual- ized, which brings about shorter onset, less dosage of local anesthetics, longer duration of analgesia and higher block success rate of SCBPB, but the complications cannot be ignored, especially respiratory distress caused by diaphragm paralysis. Therefore, it is a hot spot to minimize the incidence of diaphragmatic paralysis as far as possible under the accurate positioning of ultrasound combined with nerve stimulator.