【原】【罌粟摘要】周圍神經(jīng)阻滯后的神經(jīng)損傷：超聲引導(dǎo)對風(fēng)險和影響的評估綜述

罌粟花anesthGH 2025-06-22 發(fā)布于貴州

展開全文

周圍神經(jīng)阻滯后的神經(jīng)損傷：超聲引導(dǎo)對風(fēng)險和影響的評估綜述

貴州醫(yī)科大學(xué) 麻醉與心臟電生理課題組

翻譯：周菁編輯：王波審校：曹瑩

背景

外周神經(jīng)損傷或阻滯后神經(jīng)功能障礙（PBND）并不常見，但已被公認(rèn)為外周神經(jīng)阻滯（PNB）的并發(fā)癥。文獻中指出了其廣泛的發(fā)病率，因此需要對其發(fā)生進行批判性評估。

證據(jù)審查

在六個數(shù)據(jù)庫中進行了文獻檢索。為了進行綜述，我們將PBND定義為可歸因于PNB（當(dāng)報告時）或在PNB的背景下報告（當(dāng)未提及與PNB的關(guān)聯(lián)時）的PNB分布中的任何新發(fā)感覺運動障礙。前瞻性和回顧性研究均提供了感興趣時間點（>48小時至<2周；>2周至6周、7周至5個月、6個月至1年和>1年持續(xù)時間）PBND的發(fā)病率，以供審查。發(fā)病率數(shù)據(jù)用于提供這些時間段PBND的匯總估計值（95%置信區(qū)間）。在使用或不使用美國指南的情況下，獲得了類似的估計值來了解PBND的發(fā)病率。此外，與個體PNB相關(guān)的PBND以類似的方式獲得，上肢和下肢PNB根據(jù)針頭插入的解剖位置進行分類。

結(jié)果

PBND的總體發(fā)病率隨著時間的推移而下降，在<2周時發(fā)病率約為1%（千分之一發(fā)病率（95%CI）=9（8；至11）），在1年時約為3/10000（千分之發(fā)病率（95%CI）=0。3（0.1；至0.5））。單個PNB的PBND發(fā)病率不同，其中以鱗間阻滯的發(fā)病率最高。

結(jié)論

我們的綜述為現(xiàn)有文獻增加了信息，即神經(jīng)系統(tǒng)并發(fā)癥較罕見，但似乎某些區(qū)塊的發(fā)病率高于其他區(qū)塊。使用美國指南可能與PBND的發(fā)病率較低有關(guān)，尤其是在那些報告合并估計數(shù)較高的PNB中。未來的研究需要將PBND在不同時間點的報告及其與PNB的關(guān)聯(lián)標(biāo)準(zhǔn)化。

原始文獻來源：Lemke E, Johnston DF, Behrens MB, Seering MS, McConnell BM, Swaran Singh TS, et al. Neurological injury following peripheral nerve blocks: a narrative review of estimates of risks and the influence of ultrasound guidance. Reg Anesth Pain Med. 2023;49(2):122–32.

Neurological injury following peripheral nerve blocks: a narrative review of estimates of risks and the influence of ultrasound guidance

Background: Peripheral nerve injury or post-block neurological dysfunction (PBND) are uncommon but a recognized complications of peripheral nerve blocks (PNB). A broad range of its incidence is noted in the literature and hence a critical appraisal of its occurrence is needed.

Evidence：review A literature search was conducted in six databases. For the purposes of the review, we defined PBND as any new-onset sensorimotor disturbances in the distribution of the performed PNB either attributable to the PNB (when reported) or reported in the context of the PNB (when association with a PNB was not mentioned). Both prospective and retrospective studies which provided incidence of PBND at timepoints of interest (>48 hours to <2 weeks; >2 weeks to 6 weeks, 7 weeks to 5 months, 6 months to 1 year and >1 year durations) were included for review. Incidence data were used to provide pooled estimates (with 95% CI) of PBND at these time periods. Similar estimates were obtained to know the incidence of PBND with or without the use of US guidance. Additionally, PBND associated with individual PNB were obtained in a similar fashion with upper and lower limb PNB classified based on the anatomical location of needle insertion.

Findings ：The overall incidence of PBND decreased with time, with the incidence being approximately 1% at <2 weeks’time (Incidence per thousand (95% CI)= 9 (8; to 11)) to approximately 3/10 000 at 1 year (Incidence per thousand (95% CI)= 0. 3 (0.1; to 0.5)). Incidence of PBND differed for individual PNB with the highest incidence noted for interscalene block.

Conclusion:Our review adds information to existing literature that the neurological complications are rarer but seem to display a higher incidence for some blocks more than others. Use of US guidance may be associated with a lower incidence of PBND especially in those PNBs reporting a higher pooled estimates. Future studies need to standardize the reporting of PBND at various timepoints and its association to PNB.

END