Abstract
目的 介绍在超声定位下行锁骨下喙突入路臂丛麻醉的安全性和阻滞范围.方法对40例手术的患者,应用B超在患侧喙突内下处探到腋动脉第2段,将超声探头置于腋动脉的正上方(前胸壁的点),测量该点与喙突的距离、腋动脉的深度及其同胸膜的位置关系.其中20例上肢手术患者在B超引导下进行锁骨下臂丛神经阻滞.结果B超不能清楚地显示锁骨下臂丛的结构,但选择喙突内下2cm作为锁骨下臂丛阻滞的穿刺点是合理的.在该点腋动脉第2段的深度,左侧是2.84cm,右侧是2.78cm.穿刺点到胸膜的水平距离,左侧为8.1mm,右侧为7.7mm.腋动脉的深度和穿刺点到胸膜的距离均同病人的体重呈正相关.20例B超实时定位下行锁骨下臂丛神经阻滞的麻醉效果达95%,臂丛发出7根神经的阻滞率为40%,但其中5根神经(肌皮、正中、尺、桡、前臂内侧皮神经)的阻滞率为85%.结论在B超定位的帮助下,锁骨下入路臂丛阻滞麻醉可以达到上肢广泛区域的阻滞并可避免气胸的并发症。
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