Swenson J D, Hutchinson D T, Bromberg M, Pace N L
Department of Anesthesiology, University of Utah Medical Center, Salt Lake City 84132, USA.
Anesth Analg. 1998 Sep;87(3):677-80. doi: 10.1097/00000539-199809000-00035.
Perioperative ulnar neuropathy is a complication that occurs even in patients who seem to be appropriately padded and positioned. The disproportionately high incidence of postoperative ulnar nerve injury compared with the median and radial nerves has largely been attributed to its vulnerability to compression or stretch at the cubital tunnel. Some clinical and laboratory evidence suggests that compromise of perfusion to the upper extremity may also play a role in this complication. To determine whether the ulnar nerve is more sensitive to ischemia of the upper extremity, we studied 10 men during general anesthesia. Somatosensory evoked potentials of the radial, median, and ulnar nerves were simultaneously recorded during general anesthesia with the brachial artery occluded proximal to the cubital fossa. All three nerves showed rapid changes in signal amplitude in response to occlusion of the brachial artery, but the amplitude of the ulnar nerve was affected earlier and to a greater degree. Compared with the median nerve, the change in ulnar nerve signal amplitude during ischemia was significantly greater after 4 min (P = 0.002). This trend persisted at 6 and 8 min (P = 0.008). At 4, 6, and 8 min of ischemia, the ulnar nerve likewise showed a greater decrease in amplitude compared with the radial nerve, with corresponding P values of 0.015, 0.008, and 0.008. We conclude that the ulnar nerve is more sensitive to ischemia of the upper extremity compared with the radial and median nerves. In addition to its increased vulnerability at the elbow, compromise of arterial flow may contribute to some cases of postoperative ulnar neuropathy.
Postoperative ulnar neuropathy is thought to result from compression or stretch of the ulnar nerve at the elbow. However, patients may sustain this complication despite careful padding and positioning. This study suggests that the ulnar nerve may also be unusually sensitive to decreases in blood supply to the arm. Care should not only to properly position and pad the elbows, but also to ensure adequate perfusion of the upper extremities.
围手术期尺神经病变是一种即使在看似已适当垫好和摆放体位的患者中也会发生的并发症。与正中神经和桡神经相比，术后尺神经损伤的发生率异常高，这在很大程度上归因于其在肘管处易受压迫或拉伸。一些临床和实验室证据表明，上肢灌注受损也可能在这种并发症中起作用。为了确定尺神经是否对上肢缺血更敏感，我们在全身麻醉期间对10名男性进行了研究。在全身麻醉期间，当肱动脉在肘窝近端被阻断时，同时记录桡神经、正中神经和尺神经的体感诱发电位。所有三条神经在肱动脉阻断后信号幅度均迅速变化，但尺神经的幅度受影响更早且程度更大。与正中神经相比，缺血4分钟后尺神经信号幅度的变化明显更大（P = 0.002）。这种趋势在6分钟和8分钟时持续存在（P = 0.008）。在缺血4分钟、6分钟和8分钟时，与桡神经相比，尺神经的幅度同样有更大的下降，相应的P值分别为0.015、0.008和0.008。我们得出结论，与桡神经和正中神经相比，尺神经对上肢缺血更敏感。除了在肘部其易损性增加外，动脉血流受损可能导致一些术后尺神经病变病例。
术后尺神经病变被认为是由肘部尺神经受压或拉伸引起的。然而，尽管进行了仔细的垫衬和体位摆放，患者仍可能发生这种并发症。这项研究表明，尺神经可能对手臂血液供应减少也异常敏感。不仅要注意正确摆放肘部的位置并进行垫衬，还应确保上肢有足够的灌注。
