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頁籤選單縮合
題 名 | Ultrasound Examination for the Optimal Head Position for Interscalene Brachial Plexus Block=以超音波檢查評估施行肌間溝臂神經叢阻斷術之最佳頭部轉動姿勢 |
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作 者 | 盧奕丞; 許弘德; 蘇理盈; 盧偉; 陳太乙; 王志中; 朱光興; | 書刊名 | 麻醉學雜誌 |
卷 期 | 45:2 2007.06[民96.06] |
頁 次 | 頁73-78 |
分類號 | 416.5 |
關鍵詞 | 神經阻斷術; 臂神經叢; 斜角肌間; 超音波; Nerve block; Brachial plexus; Interscalene approach; Ultrasonography; |
語 文 | 英文(English) |
中文摘要 | 背景:體表解剖標記是傳統上用以定位肌間溝臂神經叢的方式,頭部轉動確定會影響內頸靜脈導管的置放,也可能會影響神經叢的位置,而對於肌間溝臂神經叢阻斷術目前並沒有文獻討論頭部轉動角度的影響。本試驗目的在探討頭部轉動角度對於肌間溝臂神經叢阻斷術的影響。方法:我們徵求五十三位志願者以超音波探頭模擬實際操作肌間溝臂神經叢阻斷術時的進針方式,選定五個轉頭角度,由中線向右,分別轉0°、15°、30°、45°及60°,紀錄每位受試者各個角度模擬進針路徑與臂神經叢之偏差距離、臂神經叢深度與是否穿刺血管。結果:模擬解剖標記定位之進針路徑位於臂神經叢內側,而且轉頭角度越大,內側偏差距離越大。轉頭角度大於30°比起角度小於15°,臂神經叢的深度相對較淺。模擬進針路徑穿刺內頸靜脈的機率如下述:當轉頭角度在30°之內,危險性小於5%,但角度大於45°時,此危險性則顯著提高。結論:為施行肌間溝臂神經叢阻斷術時,轉頭角度不要超過30°;而以體表標記定位肌間溝臂神經叢時,則應考慮此法有內側偏差。 |
英文摘要 | Background: Surface anatomic landmarks have traditionally been used to locate the brachial plexus in the interscalene groove. Head rotation can affect the orientation of neck vessels and may possibly affect the brachial plexus. The optimal degree of head rotation has been specified for better internal jugular vein cannulation but not for interscalene brachial plexus block. The purpose of this study was to evaluate the influence of head rotation on interscalene brachial plexus block. Methods: We simulated the needle insertion in interscalene approach to brachial plexus with the ultrasound probe to mimic the needle in the manner of actual block in 53 volunteers. Ultrasound-derived measurements were recorded to evaluate the influence of head rotation on the approach including deviation from the imitative needle path to plexus center, depth of brachial plexus and vessel intersection. Results: Medial deviation of the imitative needle path to the center of brachial plexus was found from all angles of head rotation. Increased head rotation angle of 0°, 15°, 30°, 45° and 60° from the midline was associated with increasingmedial deviation. The brachial plexus becamemore superficial if head rotation was over 30° than within the realm of 15°. The likelihood of the stimulated needle path intersecting the internal jugular vein was lower than 5% for head rotation within 30° and would become significantly higher for head rotation over 45°. Conclusions: Whenever we perform interscalene brachial plexus block, the head rotation angle should not exceed 30°. The measured medial deviation of surface landmark should be considered when it is used to approach interscalene brachial plexus. |
本系統中英文摘要資訊取自各篇刊載內容。