确定前锯肌下筋膜平面阻滞范围:尸体标本解剖  

Determining range of inferior serratus anterior fascial plane block:cadaver specimen dissection

作　　者：秦志祥[1] 李春雨[1] 李青青 陈福强 邢柏春[1] 牛香兰 贾晋太[1] Qin Zhixiang;Li Chunyu;Li Qingqing;Chen Fuqiang;Xing Baichun;Niu Xianglan;Jia Jintai(Department of Anesthesiology,Heping Hospital Affiliated to Changzhi Medical College,Changzhi 046000,China;Department of Histology and Embryology,School of Basic Medicine,Changzhi Medical College,Changzhi 046000,China)

机构地区：[1]长治医学院附属和平医院麻醉科,046000 [2]长治医学院基础医学部组织胚胎学教研室,046000

出　　处：《中华麻醉学杂志》2020年第10期1255-1257,共3页Chinese Journal of Anesthesiology

基　　金：山西省高等学校特色专业建设项目(201509);山西省高等学校教学改革创新项目(J2018139);山西省高等学校大学生创新创业项目(2015308)。

摘　　要：目的通过尸体标本解剖的方法确定前锯肌下筋膜平面阻滞的范围。方法甲醛固定的尸体标本4具,年龄18~64岁,身长163~170 cm,男女各2具,以其一侧胸壁为一研究对象,4具尸体共8个研究对象。尸体置于仰卧位,行超声引导下前锯肌下筋膜平面阻滞,注入亚甲蓝甘油果糖溶液40 ml。30 min时逐层解剖胸壁,记录不同体表标志下蓝染情况。结果胸壁解剖可见第2~6肋间神经外侧皮支呈蓝染。于锁骨中线、腋前线、腋中线和腋后线蓝染范围分别为:9.95(1.18)、11.90(1.32)、12.80(1.32)和11.35(1.22)cm。第2~9肋于腋前线、腋中线和腋后线均呈蓝染,第1肋于各个体表标志下均无蓝染,锁骨中线下,各肋骨蓝染率分别为,第2肋为0,第3肋为7/8,第4肋为7/8,第5肋为6/8,第6肋为6/8,第7肋为5/8,第8肋为4/8和第9肋为0。结论前锯肌下筋膜平面阻滞可阻滞第2~6肋间神经外侧皮支。Objective To determine the range of inferior serratus anterior fascial plane block through the method of cadaver specimen dissection.Methods Four formalin-fixed cadavers,2 males and 2 females,aged 18-64 yr,with body length of 163-170 cm,were selected,with one side of the chest wall served as a research subject and 8 research subjects in total.Cadavers were placed in the prone position.Ultrasound-guided inferior serratus anterior fascial plane block was performed.Methylene blue glycerin fructoseand solution 40 ml was administrated.The chest wall was dissected layer by layer at 30 min of injection,layers were separated into the deep serratus plane,and the range of blue staining under different body surface markers was recorded.Results Anatomy of the chest wall showed that the lateral cutaneous branch of 2nd-6th intercostal nerve were blue stained.The range of blue staining in the midline of clavicle,anterior axillary line,middle axillary line and posterior axillary line was as follows:9.95(1.18),11.90(1.32),12.80(1.32),and 11.35(1.22)cm.The 2nd to 9th ribs were blue stained at the axillary front,axillary midline and axillary posterior line.The first rib was not blue stained under various body surface markers.Under the midline of clavicle,the blue staining rates of ribs were 0 in the 2nd rib,7/8 in the 3rd rib,7/8 in the 4th rib,6/8 in the 5th rib,6/8 in the 6th rib,5/8 in the 7th rib,4/8 in the 8th rib and 0 in the 9th rib.Conclusion Inferior serratus anterior fascial plane block can block the lateral cutaneous branches of 2nd-6th intercostal nerves.

关 键 词：神经传导阻滞 药用制剂 扩散 

分 类 号：R614[医药卫生—麻醉学]