【原】【罂粟摘要】颈丛阻滞深度对膈神经阻滞影响的随机试验

---

颈丛阻滞深度对膈神经阻滞影响的随机试验

贵州医科大学麻醉与心脏电生理课题组  

翻译：安丽 编辑：陈锐 审校：曹莹

HOLIDAY

目的

颈丛阻滞通常用于促进清醒患者颈动脉内膜切除术(CEA)。根据与颈部筋膜的关系，可分为浅层、中层、深层3个部位。我们假设颈丛阻滞深度会对膈神经阻滞产生显著影响，从而影响半膈肌运动。

HOLIDAY

方法

我们在一项盲法观察随机对照试验中，选择了进行清醒CEA的45名患者，随机分为3组（每组15例）：分别接受深、中、浅颈丛阻滞，使用0.5%罗哌卡因20ml 与MRI造影剂混合。观察实施阻滞前后，经腹部超声测量膈肌运动，并对受试的患者进行颈部MRI检查，以评估注射剂的扩散，以及肺功能测量。主要结果是研究组间强迫吸气时同侧半膈肌运动的差异。

HOLIDAY

结果

术后，同侧膈肌的强迫吸气运动：浅、中、深层颈丛阻滞分别为（4.34±1.06cm,3.86±1.24cm,2.04±1.20cm），各阻滞组之间的差异有统计学意义（p<0.001）。在正常吸气过程中也发现了差异。肺功能、氧饱和度、并发症发生率和患者满意度没有差异。MRI研究表明，在浅表筋膜有明显的渗透，但注射液在靶区内的扩散很容易区分。

HOLIDAY

结论

通过不同的注射深度探究了颈丛阻滞的特点和副作用，并在颈深丛阻滞组中，膈肌功能障碍最为明显。

HOLIDAY

原始文献来源

Mathias Opperer, Reinhard Kaufmann, Matthias Meissnitzer, Florian K Enzmann , Christian Dinges, Wolfgang Hitzl, Jürgen Nawratil, Andreas Koköfer.Depth of cervical plexus block and phrenic nerve blockade: a randomized trial.Reg Anesth Pain Med 2022 Jan 10.DOI：10.1136/rapm-2021-102851.

---

Depth of cervical plexus block and phrenic nerve blockade: a randomized tria

Abstract

Background and objectives:Cervical plexus blocks are commonly used to facilitate carotid endarterectomy (CEA) in the awake patient. These blocks can be divided into superficial, intermediate, and deep blocks by their relation to the fasciae of the neck. We hypothesized that the depth of block would have a significant impact on phrenic nerve blockade and consequently hemi-diaphragmatic motion.

Methods:We enrolled 45patients in an observer blinded randomized controlled trial, scheduled for elective, awake CEA. Patients received either deep, intermediate, or superficial cervical plexus blocks, using 20mL of 0.5% ropivacaine mixed with an MRI contrast agent. Before and after placement of the block, transabdominal ultrasound measurements of diaphragmatic movement were performed. Patients underwent MRI of the neck to evaluate spread of the injectate, as well as lung function measurements. The primary outcome was ipsilateral difference of hemi-diaphragmatic motion during forced inspiration between study groups.

Results:Postoperatively, forced inspiration movement of the ipsilateral diaphragm (4.34±1.06, 3.86±1.24, 2.04±1.20 (mean in cm±SDfor superficial, intermediate and deep, respectively)) was statistically different between block groups (p<0.001). Differences were also seen during normal inspiration. Lung function, oxygen saturation, complication rates, and patient satisfaction did not differ. MRI studies indicated pronounced permeation across the superficial fascia, but nevertheless easily distinguishable spread of injectate within the targeted compartments.

Conclusions:We studied the characteristics and side effects of cervical plexus blocks by depth of injection. Diaphragmatic dysfunction was most pronounced in the deep cervical plexus block group.