赵达强-超声引导上肢神经阻滞

超声引导上肢神经阻滞2016.12.17.上海市第六人民医院ShanghaiSixthPeople’sHospital上海市第六人民医院ShanghaiSixthPeople’sHospital上肢的神经支配上海市第六人民医院ShanghaiSixthPeople’sHospital病例一：桡骨远端骨折内固定手术上海市第六人民医院ShanghaiSixthPeople’sHospital神经阻滞入路选择适应症肩部、锁骨、上臂近端手术臂丛神经置管肱骨中段以下上肢肘部以下臂丛神经置管同锁骨下入路缺点缺乏超声引导阻滞较难1.受体位限制2.需要单独阻滞肌皮神经并发症刺伤锁骨下血管刺伤腋血管上海市第六人民医院ShanghaiSixthPeople’sHospital上海市第六人民医院ShanghaiSixthPeople’sHospital上海市第六人民医院ShanghaiSixthPeople’sHospital上海市第六人民医院ShanghaiSixthPeople’sHospitalUrmeyWF,TaltsKH,SharrockNE.Onehundredpercentincidenceofhemidiaphragmaticparesisassociatedwithinterscalenebrachialplexusanesthesiaasdiagnosedbyultrasonography.AnesthAnalg1991;72:498-503.上海市第六人民医院ShanghaiSixthPeople’sHospital膈神经阻滞—USVSNS上海市第六人民医院ShanghaiSixthPeople’sHospital膈神经阻滞—5MLVS10ML上海市第六人民医院ShanghaiSixthPeople’sHospital膈神经阻滞—extrafascialinjection上海市第六人民医院ShanghaiSixthPeople’sHospital锁骨上上海市第六人民医院ShanghaiSixthPeople’sHospital锁骨下上海市第六人民医院ShanghaiSixthPeople’sHospital腋路上海市第六人民医院ShanghaiSixthPeople’sHospital神经阻滞的选择肌间沟+腋路取长补短NervesGroupS(n=40)GroupC(n=40)PvalueAxillaryRadialMedianUlnarMusculocutaneousMCNAMCNFAIntercostobrachialTotal0/7/330/10/300.4120/6/340/8/320.5562/9/291/13/260.8789/18/130/12/280.0000/15/250/18/220.4968/21/110/12/280.0039/19/120/10/300.01340/0/00/9/310.00068/95/1571/92/2270.000上海市第六人民医院ShanghaiSixthPeople’sHospital病例二上海市第六人民医院ShanghaiSixthPeople’sHospital麻醉遇到的问题上海市第六人民医院ShanghaiSixthPeople’sHospital皮肤、肌肉、锁骨的神经支配上海市第六人民医院ShanghaiSixthPeople’sHospital•锁骨上神经•胸内侧神经•胸外侧神经•胸锁乳突肌肌支•锁骨下神经•副神经斜方肌支需要阻滞的神经上海市第六人民医院ShanghaiSixthPeople’sHospital超声引导锁骨上神经&臂丛阻滞1前斜角肌2中斜角肌3后斜角肌4胸锁乳突肌5颈外静脉6臂丛7锁骨上神经上海市第六人民医院ShanghaiSixthPeople’sHospital病例三上海市第六人民医院ShanghaiSixthPeople’sHospital病例四上海市第六人民医院ShanghaiSixthPeople’sHospitalDouble-crush—双重打击UptonAR,McComasAJ.Thedoublecrushinnerveentrapmentsyndromes.Lancet.1973Aug18;2(7825):359-62.OstermanAL.Thedoublecrushsyndrome.OrthopClinNorthAm.1988Jan;19(1):147-55.0.WilliamJ,JohnC.Thedoublecrushsyndrome.JHandSurgAm.2013Apr;38(4):799-801.KanePM,DanielsAH,AkelmanE.Doublecrushsyndrome.JAmAcadOrthopSurg.2015Sep;23(9):558-62.上海市第六人民医院ShanghaiSixthPeople’sHospital手术部位皮肤神经支配上海市第六人民医院ShanghaiSixthPeople’sHospital臂内侧皮神经、前臂内侧皮神经阻滞上海市第六人民医院ShanghaiSixthPeople’sHospital腕管综合征上海市第六人民医院ShanghaiSixthPeople’sHospital总结上海市第六人民医院ShanghaiSixthPeople’sHospital谢谢聆听