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題名 | The Feasibility of Surface Landmark for Coracoid Infraclavicular Brachial Plexus Block by Ultrasonographic Assessment=經超音波評估表面解剖定位對於喙突鎖骨下臂神經叢阻斷術之可行性 |
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作者 | 郭易維; 盧奕丞; 顏睦坤; 蘇理盈; 盧偉; 朱光興; | 書刊名 | 麻醉學雜誌 |
卷期 | 45:1 2007.03[民96.03] |
頁次 | 頁27-32 |
分類號 | 416.5 |
關鍵詞 | 超音波; 臂神經叢; 鎖骨下; 神經阻斷術; Ultrasonography; Brachial plexus; Infraclavicular approach; Nerve block; |
語文 | 英文(English) |
中文摘要 | 背景:喙突鎖骨下臂神經叢阻斷術,最初由Whiffer提出,此法比鎖骨下臂神經叢阻斷術更為安全而簡便。此法的解剖定位點為喙突往下2公分往內2公分。我們設計一前瞻性試驗以超音波來評估此解剖定位點的可行性。方法:徵求80名健康自願者,接受超音波儀器檢測鎖骨下區域,超音波沿著喙突內側2公分之垂直線掃描。解剖定位點定義作C點;以超音波檢測調整之定位點定義作U點。在超音波檢查確認神經血管叢之後,我們檢測解剖定位的準確度與紀錄超音波測量值。人口學資料則用以比對C點與U點偏差值之統計相關性。結果:經由表面解剖定位方式實行喙突鎖骨下臂神經叢阻斷術之準確度為74.4%;可知此法在臨床實行上無法成為足以信賴的方式。我們發現U點比C點明顯趨向頭側2.95毫米(95%信賴區間,1.2~4.7毫米)。另外發現女性在U點比C點趨向頭側5.12毫米(95%信賴區間,2.91~7.33毫米),有顯著的差異(P<0.001);在男性方面U點與C點較無顯著的差異。結論:臨床上,建議以超音波導引方式來實行喙突鎖骨下臂神經叢阻斷術,因為表面解剖定位的準確度不夠且個體差異大;若無法取得此設備,性別上測量的差異則應需要被考慮。 |
英文摘要 | Background: The coracoid infraclavicular block first introduced by Whiffler provides a safer and easily approach than classic infraclavicular block. In this technique, the anatomy-based puncture site is 2 cm medial and 2 cm caudal from the coracoid process. This prospective study was purposed to evaluate the feasibility of surface landmark-based coracoid block by ultrasonography. Methods: High-frequency ultrasonographic examination was performed in 80 volunteers along the vertical line 2 cm medial to the coracoid process. The C point (C) is defined as landmark-based puncture site. The U point (U) is defined as the ultrasonographically modified optimal puncture site. After identifying the neurovascular bundle, the extent of precision based on landmark was examined and ultrasonographic measurements were also done. Demographic data was applied to correlate with the deviation between C and U. Results: The landmark-based puncture site for coracoid infraclavicular block was found to have a fair precision rate of 74.4%, although not high enough to provide a reliable puncture in daily practice. There was a significant trend toward amore superior puncture site of 2.95mm(95%CI, 1.2-4.7). In female subjects, U was 5.12mm(95% CI, 2.91-7.33) superior to C which was statistically significantly (P < 0.001). In male subjects, U was not significantly superior to C. Conclusions: Ultrasonographic guidance is suggested whenever anatomical precision is inadequate or meeting with great individual bodily variance which renders landmark-based technique difficult. However, if this facility is not available, the gender discrepancy in measurement should be seriously considered when coracoid process is used as the landmark. |
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