超声在锁骨上臂丛神经阻滞定位中的应用

目的 研究锁骨上臂丛神经与其周围组织结构的毗邻关系,为超声引导下锁骨上臂丛神经阻滞的临床优化应用提供解剖学基础.方法 应用超声对200例ASAⅠ-Ⅱ级患者的左右双侧锁骨上臂丛神经进行检查,记录所有的声像图,采用二维超声影像工作站测定锁骨上臂丛神经和锁骨下动脉的中心连线与皮肤的夹角及两者中心的水平距离,皮肤到臂丛神经、锁骨下动脉、第一肋骨的距离.应用多因素线性回归分析身高、体质量、年龄等变量与锁骨上臂丛神经的距离的相关性.结果锁骨上臂丛神经和锁骨下动脉的中心连线与皮肤的夹角:左侧(45.3±17.2)°,右侧(46.3±17.6)°;锁骨上臂丛神经和锁骨下动脉的中心水平距离:左侧(0.53±0.17)cm,右侧(0.53±0.18)cm;皮肤到锁骨下动脉的距离:左侧(1.51±0.39)cm,右侧(1.46±0.39)cm;皮肤到第一肋骨的深度距离:左侧(2.23±0.40)cm,右侧(2.23±0.41)cm;皮肤到锁骨上臂丛神经的深度距离:左侧(0.97±0.29)cm,右侧(0.95±0.29)cm.所有测量数据左右两侧相比,差异均无统计学意义(P＞0.05).左、右侧皮肤到锁骨上臂丛神经的距离与身高、体质量存在相关性,其相关系数:左侧0.45,右侧0.52.结论 超声可清楚地显示锁骨上臂丛神经及其周围组织结构.在横断面声像图中,锁骨上臂丛神经主要位于锁骨下动脉的外上方.

Application of Ultrasound Location in Supraclavicular Brachial Plexus Block

Objective To research the relationship between the supraclavicular brachial plexus and the tissue around it under sonography,and to offer relevant anatomical variants to further optimize the clinical application of ultrasound-guided supraclavicular brachial plexus block.MethodsTwo hundred ASAⅠ-Ⅱ patients were recruited and ultrasound images of supraclavicular brachial plexus（SBP） and subclavian artery（SA） were obtained.The angle between the skin line and SBP-to-SA centre line,and the distance of skin-to-SA,skin-to-first rib and skin-to-SBP were measured with ultrasound workstation.The relevance between the variables（such as height,weight,age） and distance of skin-to-SBP was analyzed by multi-factor linear regression.Results The angle between skin line and SBP-to-SA centre line was（45.3±17.2） degree（left） and（46.3±17.6） degree（right）.The distance of SBP-to-SA was（0.53±0.17） cm（left） and（0.53±0.18） cm（right）.The skin-to-SA distance was（1.51±0.39）cm（left） and（1.46±0.39）cm（right）.The skin-to-first rib distance was（2.23±0.40） cm（left） and（2.23±0.41） cm（right）.The skin-to-SBP distance was（0.97±0.29） cm（left） and（0.95±0.29） cm（right）.The skin-to-SBP distance had a medial correlation with weight and height（left：r=0.45;right：r=0.52）.Conclusion The sonography can provide high-quality ultrasound images in supraclavicular location.The SBP is lateral to SA in the transversal ultrasound images.