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学习笔记|局部麻醉之臂丛神经阻滞麻醉

  • 2026-05-12 13:00:26
学习笔记|局部麻醉之臂丛神经阻滞麻醉
图片来自：小红📖：爱学习的小橘子
   臂丛神经阻滞是上肢手术常用的麻醉方法，通过在臂丛神经的不同位置注射麻醉药，实现对上肢的麻醉。
   三种经典入路：肌间沟入路、锁骨上入路和腋路入路，主要区别在于穿刺位置、阻滞效果和适用手术范围。 选择哪种入路，麻醉医生会根据手术部位、患者情况和设备条件综合判断。
肌间沟入路：肩部手术的“首选”
穿刺位置：位于颈部，双侧胸锁乳突肌之间形成的肌间沟内，主要作用于C5-C6神经根。

主要优点：能有效阻滞肩部及上臂近端的神经，是肩关节手术（如肩峰区肿物切除）的常用选择。气胸发生率相对较低。
主要缺点：对上臂内侧和手部的阻滞效果相对较弱。 另外，此入路有损伤膈神经的风险，可能影响呼吸，因此有严重呼吸系统疾病（如COPD）的患者需慎用。
锁骨上入路：覆盖范围广，但有风险
穿刺位置：在锁骨中点上方约1-1.5cm处，作用于臂丛神经的干或束。

主要优点：能为从上臂中段到手部的手术提供广泛的麻醉效果，起效快，用药量相对较少。
主要缺点：此入路紧邻肺尖，穿刺时有刺破胸膜导致气胸的风险，因此必须在超声引导下进行，以确保安全。
腋路入路：手部手术的“安全港”
穿刺位置：在腋窝内，围绕腋动脉周围的臂丛神经终末分支（如正中神经、尺神经、桡神经等）。

主要优点：此区域没有重要的血管和神经干，操作相对安全，并发症少。 是前臂、手腕和手部手术（如手外科手术）的首选方法。
主要缺点：通常无法阻滞到腋神经，因此对肩部和三角肌区域的麻醉效果不佳。 此外，由于神经呈分散的束状，可能需要分次注射，操作相对复杂。

那该选择哪种入路呢？
麻醉医生会根据具体情况选择最合适的方案，有时不只是一条神经阻滞也会选择多条：
肩部手术：通常选择肌间沟入路。
肘部及以下手术：锁骨上或锁骨下入路是常见选择，但锁骨上入路需警惕气胸风险。
手部精细手术：腋路入路因其安全性高而被广泛采用。

值得注意的是，随着超声引导技术的普及，医生可以更清晰地看到神经和血管的结构，大大提高了神经阻滞的安全性和成功率。 因此，无论选择哪种入路，超声引导都已成为标准操作。
    图片来自：小红📖：Luffy主理人

护理要点

1、术前了解患者有无局部麻醉药过敏史。

2、对于在锁骨上和肋间隙进行阻滞者，观察有无气胸等并发症的发生。

3、使用心电监测、氧气吸入，观察呼吸情况。

4、患侧有无麻木无力症状，如有特殊情况及时通知值班医生及麻醉科医生。

 部分图文来源于网络丨侵删！本文仅用于同事交流学习
本文来自网友投稿或网络内容，如有侵犯您的权益请联系我们删除，联系邮箱：wyl860211@qq.com 。

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  1. CONNECT:[ UseTime:0.000869s ] mysql:host=127.0.0.1;port=3306;dbname=no_67808;charset=utf8mb4
  2. SHOW FULL COLUMNS FROM `fenlei` [ RunTime:0.000714s ]
  3. SELECT * FROM `fenlei` WHERE `fid` = 0 [ RunTime:0.005865s ]
  4. SELECT * FROM `fenlei` WHERE `fid` = 63 [ RunTime:0.000287s ]
  5. SHOW FULL COLUMNS FROM `set` [ RunTime:0.000486s ]
  6. SELECT * FROM `set` [ RunTime:0.000198s ]
  7. SHOW FULL COLUMNS FROM `article` [ RunTime:0.000578s ]
  8. SELECT * FROM `article` WHERE `id` = 488067 LIMIT 1 [ RunTime:0.001234s ]
  9. UPDATE `article` SET `lasttime` = 1778595446 WHERE `id` = 488067 [ RunTime:0.017677s ]
  10. SELECT * FROM `fenlei` WHERE `id` = 65 LIMIT 1 [ RunTime:0.000684s ]
  11. SELECT * FROM `article` WHERE `id` < 488067 ORDER BY `id` DESC LIMIT 1 [ RunTime:0.001619s ]
  12. SELECT * FROM `article` WHERE `id` > 488067 ORDER BY `id` ASC LIMIT 1 [ RunTime:0.005222s ]
  13. SELECT * FROM `article` WHERE `id` < 488067 ORDER BY `id` DESC LIMIT 10 [ RunTime:0.013746s ]
  14. SELECT * FROM `article` WHERE `id` < 488067 ORDER BY `id` DESC LIMIT 10,10 [ RunTime:0.004720s ]
  15. SELECT * FROM `article` WHERE `id` < 488067 ORDER BY `id` DESC LIMIT 20,10 [ RunTime:0.001726s ]
0.128387s