Cheney F W, Domino K B, Caplan R A, Posner K L
Department of Anesthesiology, University of Washington School of Medicine, Seattle 98195, USA.
Anesthesiology. 1999 Apr;90(4):1062-9. doi: 10.1097/00000542-199904000-00020.
Nerve injury associated with anesthesia is a significant source of morbidity for patients and liability for anesthesiologists. To identify recurrent and emerging patterns of injury we analyzed the current American Society of Anesthesiologists (ASA) Closed Claims Project Database and performed an in-depth analysis of claims for nerve injury that were entered into the database since the authors' initial report of the subject.
The ASA Closed Claims Database is a standardized collection of case summaries derived from the closed claims files of professional liability insurance companies. Claims for nerve injury that were not included in the authors' 1990 report were reviewed in-depth.
Six hundred seventy (16% of 4,183) claims were for anesthesia-related nerve injury. The most frequent sites of injury were the ulnar nerve (28%), brachial plexus (20%), lumbosacral nerve root (16%), and spinal cord (13%). Ulnar nerve (85%) injuries were more likely to have occurred in association with general anesthesia, whereas spinal cord (58%) and lumbosacral nerve root (92%) injuries were more likely to occur with regional techniques. Ulnar nerve injury occurred predominately in men (75%) and was also more apt to have a delayed onset of symptoms (62%) than other nerve injuries. Spinal cord injuries were the leading cause of claims for nerve injury that occurred in the 1990s.
New strategies for prevention of nerve damage cannot be recommended at this time because the mechanism for most injuries, particularly those of the ulnar nerve, is not apparent.
与麻醉相关的神经损伤是患者发病的重要原因，也是麻醉医生面临责任的来源。为了识别损伤的复发和新出现模式，我们分析了美国麻醉医师协会（ASA）当前的封闭索赔项目数据库，并对自作者首次报告该主题以来录入数据库的神经损伤索赔进行了深入分析。
ASA封闭索赔数据库是一个标准化的病例摘要集合，源自专业责任保险公司的封闭索赔文件。对作者1990年报告中未包括的神经损伤索赔进行了深入审查。
670例（4183例中的16%）索赔是关于麻醉相关神经损伤的。最常见的损伤部位是尺神经（28%）、臂丛神经（20%）、腰骶神经根（16%）和脊髓（13%）。尺神经损伤（85%）更可能与全身麻醉相关，而脊髓损伤（58%）和腰骶神经根损伤（92%）更可能与区域技术相关。尺神经损伤主要发生在男性（75%），且与其他神经损伤相比，更易出现症状延迟发作（62%）。脊髓损伤是20世纪90年代发生的神经损伤索赔的主要原因。
目前无法推荐预防神经损伤的新策略，因为大多数损伤，尤其是尺神经损伤的机制尚不清楚。
