超声引导颌神经阻滞在正颌手术中的应用现状与研究进展

Application and research progress on ultrasound-guided jaw nerve block's application in orthognathic surgery

摘要:

随着社会经济的进步，麻醉学、外科学以及特殊手术器械的运用，牙颌面畸形的外科矫治取得了快速发展。正颌手术是改善错畸形最有效的方式，但是因其创伤大且颌面部神经丰富，患者术后常伴有剧烈疼痛。疼痛可导致患者一系列生理和心理的变化，影响早期康复和功能锻炼。正颌手术术后多合并术区肿胀和张口受限，阿片类药物的镇痛方案并不适宜于该类患者，在充分镇痛的基础上，需尽量避免恶心呕吐、呼吸抑制等并发症的发生。超声引导颌神经阻滞技术不仅有满意的镇痛效果、术中出血少、促进术后早期功能锻炼，还具有阻滞精确、操作简便、安全性高等优点。该文对常见的正颌手术类型、颌神经的走行及支配、传统颌神经阻滞与超声引导颌神经阻滞、颌神经阻滞的临床效果、超声引导颌神经阻滞的研究和操作方法等作一综述，以期为超声引导颌神经阻滞在正颌手术中的应用提供参考。牙合

关键词:牙颌面畸形;正颌手术;超声引导;颌神经阻滞;镇痛

Abstract:

The advancement of social economy promotes the establishment of anesthesia and surgery and the application of special surgical instruments, thus boosting the rapid development of the surgical treatment targeted at dento-maxillofacial deformities. Orthognathic surgery is the most effective treatment to improve malocclusion. Due to large trauma and abundant innervation of maxillofacial nerves, patients often experience severe pains after operation. Pains can lead to physiological and psychological changes in patients and affect early rehabilitation and functional exercise. Because of the swelling of the surgery site and the limitation of opening mouth after orthognathic surgery, opioid medicine is not suitable for such patients. Based on sufficient analgesia, it is necessary to avoid the onset of complications such as nausea, vomiting and respiratory depression as far as possible. Ultrasound-guided jaw nerve block technique can not only provide satisfactory analgesic effect, reduce intraoperative bleeding and promote early postoperative functional exercise, but also is accurate, user-friendly and quite secure. This paper mainly describes the clinical effect of jaw nerve block, the research and operational procedures of ultrasound-guided jaw nerve block, in order to provide reference for the application of this technology in orthognathic surgery.

Key words:dento-maxillofacial deformity;orthognathic surgery;ultrasound-guided;jaw nerve block;analgesia