超声引导下臂丛神经阻滞用于慢性肾脏病患者上肢手术的有效性与安全性研究进展

Research Progress on the Efficacy and Safety of Ultrasound-Guided Brachial Plexus Block in Upper Limb Surgery for Patients with Chronic Kidney Disease

摘要: 慢性肾脏病(Chronic kidney disease, CKD)是以肾脏结构与功能长期受损为核心特征的一类疾病，病情进展可引发全身多系统并发症，显著增加上肢手术围术期麻醉管理难度。超声引导下臂丛神经阻滞作为可视化区域阻滞技术，具有定位精准、可控性好、安全性高等特点，在CKD患者上肢手术中的应用日趋广泛。本文结合近年临床研究进展，从有效性与安全性角度对该技术的应用现状进行综述，分别阐述其在血管通路手术及上肢骨科创伤手术中的应用价值，分析不同阻滞入路、局部麻醉药物及佐剂对阻滞效果的影响，探讨CKD患者病理生理改变对局麻药药代动力学与药效动力学的作用机制，并对目前存在的问题及研究方向进行总结，旨在为临床麻醉方案的优化与选择提供参考。

Abstract: Chronic kidney disease (CKD) is a category of diseases characterized by long-term damage to renal structure and function. Disease progression may lead to systemic multisystem complications, which significantly increases the difficulty of perioperative anesthetic management for upper extremity surgery. As a visualized regional anesthetic technique, ultrasound-guided brachial plexus block features precise localization, favorable controllability and high safety, and has been increasingly applied in upper extremity surgery among patients with CKD. Combined with recent advances in clinical research, this paper reviews the current application status of this technique from the perspectives of efficacy and safety. It elaborates on its application value in vascular access surgery and upper extremity orthopedic trauma surgery respectively, analyzes the effects of different block approaches, local anesthetics and adjuvants on block efficacy, explores the pathophysiological changes of CKD patients on the pharmacokinetics and pharmacodynamics of local anesthetics, and summarizes existing problems and research directions, so as to provide references for the optimization and selection of clinical anesthetic regimens.