Tomlinson D L, Hirsch I A, Kodali S V, Slogoff S
J Thorac Cardiovasc Surg. 1987 Aug;94(2):297-301.
Injury to the brachial plexus was prospectively assessed in 335 patients undergoing median sternotomy for cardiac operation. All patients were placed in the hand-up position (elbows elevated, arms abducted 90 degrees, and elbows flexed) after right internal jugular vein cannulation (23 cannulation attempts were bilateral). Twenty-eight patients had new upper extremity complaints after the operation, of whom 16 (4.8%) had symptoms considered related to injury of the brachial plexus: one with generalized weakness of the left arm, six with localized weakness, pain, or paresthesia plus objective hypesthesia or weakness, and nine with paresthesias but no objective signs. Four injuries were right sided, four left sided, and eight bilateral. At the time of discharge, 15 of 16 were symptom free and the patient with generalized weakness was rapidly improving. Postoperative plexopathy was not related to degree of sternal retraction, dissection of the internal mammary artery, or cannulation of the internal jugular vein. We believe the low incidence and benign course of brachial plexus problems in these patients resulted from careful sternal retraction and use of the hands-up position. Finally, our data do not support internal jugular cannulation as a major cause of plexus injuries after median sternotomy.
对335例接受心脏手术正中开胸的患者进行了臂丛神经损伤的前瞻性评估。所有患者在右颈内静脉置管后（23次置管尝试为双侧）均采取手部上举位（肘部抬高，手臂外展90度，肘部屈曲）。28例患者术后出现新的上肢不适，其中16例（4.8%）出现被认为与臂丛神经损伤相关的症状：1例左臂广泛性无力，6例局部无力、疼痛或感觉异常加客观感觉减退或无力，9例仅有感觉异常但无客观体征。4例损伤为右侧，4例为左侧，8例为双侧。出院时，16例中有15例无症状，广泛性无力的患者正在迅速好转。术后臂丛神经病变与胸骨牵开程度、胸廓内动脉解剖或颈内静脉置管无关。我们认为这些患者臂丛神经问题的低发生率和良性病程是由于小心的胸骨牵开和手部上举位的使用。最后，我们的数据不支持颈内静脉置管是正中开胸术后臂丛神经损伤的主要原因这一观点。
