Jellish W S, Blakeman B, Warf P, Slogoff S
Department of Anesthesiology, Loyola University Medical Center, Maywood, IL 60153, USA.
Anesth Analg. 1997 Feb;84(2):260-5. doi: 10.1097/00000539-199702000-00005.
This study compares the hands-up (HU) with the arms at side (AAS) position to determine whether one is beneficial in reducing brachial plexus stress during asymmetric sternal retraction. Eighty patients undergoing cardiac surgery were assigned to either Group 1 (AAS) or Group 2 (HU). Perioperative neurologic evaluations of the brachial plexus were performed and somatosensory evoked potentials (SSEPs) were collected during internal mammary artery harvest using asymmetric sternal retraction. Demographic data, SSEP changes, and postoperative brachial plexus symptoms were compared between groups. SSEP amplitude decreased in 95% of all patients during retractor placement with substantial decreases (> 50%) observed on the left side in 50% of the AAS and 35% of the HU patients. Amplitude recovery was normally seen in both groups after asymmetric retractor removal. Similar changes were noted, to a lesser degree, on the right side. During asymmetric sternal retraction, HU positioning offered minimal benefit in reducing brachial plexus stress as measured by SSEP. Three of the seven AAS patients who reported brachial plexus symptoms had an ulnar nerve distribution of injury. However, none of the four patients with plexus symptoms in the HU group had ulnar nerve problems, suggesting that the higher incidence of postoperative symptoms observed with AAS positioning may occur from ulnar nerve compression.
本研究比较了双手上举（HU）位与双臂放于身体两侧（AAS）位，以确定在不对称胸骨牵开过程中哪种体位有助于减轻臂丛神经压力。80例行心脏手术的患者被分为1组（AAS位）或2组（HU位）。在使用不对称胸骨牵开器获取胸廓内动脉期间，对臂丛神经进行围手术期神经学评估并收集体感诱发电位（SSEP）。比较两组间的人口统计学数据、SSEP变化及术后臂丛神经症状。在放置牵开器期间，95%的患者SSEP波幅下降，在AAS组50%的患者及HU组35%的患者中，左侧观察到显著下降（>50%）。在移除不对称牵开器后，两组均可见波幅恢复正常。右侧也观察到类似变化，但程度较轻。在不对称胸骨牵开过程中，通过SSEP测量，HU位在减轻臂丛神经压力方面益处极小。报告有臂丛神经症状的7例AAS组患者中有3例存在尺神经分布区损伤。然而，HU组有丛神经症状的4例患者中无一例存在尺神经问题，这表明AAS位术后症状发生率较高可能是由尺神经受压所致。
