一种简单的、无需几何计算或复杂体表标志的坐骨神经定位法  

作　　者：Anupama Wadhwa Heather Tlucek Daniel Sessler 谢珺田（译） 宋文阁（校） 

机构地区：[1]Department of Anesthesinology and Perioperative Medicine, University of Louisville, Louisville,I（entud~ [2]Department of Outcones Research, The Cleveland Clinic, cleveland, Ohio.Heather Tlucek is currently at the Department of Pain Medicine, The Cleveland Clinic, develand, Ohio [3]不详

出　　处：《麻醉与镇痛》2011年第6期68-73,共6页Anesthesia & Analgesia

摘　　要：背景外周神经阻滞要达到完善的下肢镇痛时，坐骨神经阻滞是必要的。我们首先在新鲜尸体上辨认坐骨神经与坐骨结节的关系，而后比较传统入路与本研究入路阻滞坐骨神经效果的差异。我们还特别评估了患者于俯卧位穿刺时，新方法（改变进针点为距坐骨结节外侧3cm）是否能减少穿刺针调整次数及缩短操作时间。方法在20具尸体上辨认坐骨神经与坐骨结节的位置关系，利用这些资料设计坐骨神经穿刺的新入路。然后进行随机对照交叉病例研究，将俯卧位经臀肌下穿刺（传统入路，n=19）与新入路，即俯卧位经坐骨结节外侧3crn穿刺点（n=20）进行了比较。记录穿刺针调整次数以及1．5mA电流刺激下出现坐骨神经刺激性抽动和〈0．5mA电流刺激下出现抽动所需时间。结果尸体俯卧位解剖坐骨神经距坐骨结节中点的平均距离为2．8±0．4cm。从体表标记点穿刺，由研究入路进针时，针尖可正对坐骨神经截面；而由传统穿刺入路进针则针尖偏于外侧，距坐骨神经2．27±0．47cm。临床上，与传统入路穿刺相比，本研究入路穿刺至出现坐骨神经刺激性抽动，穿刺针所需调整次数较少。55％的患者由传统入路穿刺不能引发抽动反应，之后改用由研究入路进针。在研究入路组和传统入路失败转为研究入路的患者中，1次进针即出现坐骨神经刺激性抽动者占45％，穿刺针调整次数≤3次出现抽动者占85％。结论俯卧位下准确定位坐骨神经时，本研究入路比传统臀肌下入路更为有效。BACKGROUND： Blockade of the sciatic nerve is necessary for complete analgesia of the lower extremity u- sing peripheral nerve blocks. We identified the sciatic nerve in relation to the ischial tuberosity in fresh cadaver dissections as well as in patients to compare sciatic nerve blockade using the conventional approach versus our experimental approach. Spe- cifically, we tested the hypothesis that in patients in the prone position, our novel approach （changing the point of needle in- sertion to 3 cm lateral from the ischial tuberosity） requires fewer needle passes and less time. METHODS： The location of the sciatic nerve in relation to the ischial tuberosity was identified in 20 cadavers; this information was used to devise an al- ternative approach to the sciatic nerve. In a randomized, controlled, crossover patient study, we compared a prone subgluteal approach （conventional approach, n = 19） with an experimental approach with the insertion point 3 cm lateral to the mid- point of ischial tuberosity with patients in prone position （n = 20）. We recorded the number of passes and the time taken to obtain an initial sciatic nerve twitch at a current of 1. 5 mA and a twitch at 0.5 mA. RESULTS： The sciatic nerve averaged 2.8 ± 0.4 cm from the midpoint of ischial tuberosity in cadavers in prone position. When needles were inserted from sur- face landmarks, those inserted through the experimental insertion point consistently transected the sciatic nerve. In contrast, needles inserted through the conventional approach were 2.27 ± 0. 47 cm lateral to the sciatic nerve. Clinically, our experi- mental approach required fewer passes to obtain a sciatic nerve twitch than the conventional approach. We were unable to obtain a twitch in 55% of patients with the conventional approach and converted them to the experimental approach. In pa- tients originally assigned to the experimental approach and those switched to the experimental approach after failure with the conventional approach, we obtained the first s

关 键 词：坐骨神经阻滞 体表标志 定位法 外周神经阻滞 坐骨结节 新鲜尸体 新入路 穿刺针 

分 类 号：R614.4[医药卫生—麻醉学]