超声引导儿童神经阻滞中国专家共识（2025版）

doi:10.3969/j.issn.1674-8115.2025.09.001

摘要/Abstract

摘要：

超声引导儿童神经阻滞的研究近年来取得重要进展，其安全性和有效性的提高得益于高精度超声可视化技术。超声技术在临床上的应用和普及，使得临床医师能够清晰、个体化地辨识儿童的神经结构和周围组织，能实时地观察到药物的扩散，显著降低了传统盲穿法带来的并发症风险。该共识基于循证医学证据和临床实践经验，结合超声引导儿童神经阻滞的发展历程和现状，系统论述儿童神经解剖学特点及其对阻滞技术的影响；明确儿童神经阻滞的适应证和禁忌证；规范实施神经阻滞前的设备准备、药物配置和儿童镇静方案；详细阐述不同部位神经阻滞的实施步骤和技术要点，包括探头选择、进针路径和局部麻醉药物扩散的实时监测；分析了主要并发症及相应的预防处理策略。经专家组深入讨论，根据共同决定的规则形成了推荐意见，最终制定了共识，以期对临床麻醉和疼痛诊疗中超声引导儿童神经阻滞的实施提供实践参考，从而推动超声引导儿童神经阻滞在临床实践中更安全有效的应用，最终实现减轻儿童痛苦、加速术后康复的目标。

关键词: 神经阻滞, 超声, 儿童, 专家共识

Abstract:

Ultrasound-guided nerve blocks in children have made significant progress in recent years, with improved safety and efficacy attributed to high-resolution ultrasound visualization. The widespread clinical adoption of ultrasound technology empowers clinicians to visualize pediatric neural structures and adjacent tissues clearly and individually, which permits real-time observation of local anesthetic spread, thereby markedly lowering complication risks inherent to conventional blind puncture techniques. This expert consensus is based on evidence-based medicine and clinical practical experiences, integrating the development history and current status of ultrasound-guided pediatric nerve blocks. It systematically elaborates on the anatomical characteristics of pediatric nerves and their impact on blocking techniques, clarifies the indications and contraindications for pediatric nerve blocks, and standardizes equipment preparation, drug formulation, and pediatric sedation protocols prior to nerve block administration. It also comprehensively provides the procedural guidance and technical key points for nerve blocks in different regions, including probe selection, needle insertion pathways, and real-time monitoring of local anesthetic diffusion, and analyzes the potential complications along with corresponding prevention and management strategies. Through in-depth discussions among the expert group, recommendations were formed based on jointly established criteria. The final consensus aims to provide practical guidance for the implementation of ultrasound-guided pediatric nerve blocks in clinical anesthesia and pain management, thereby promoting more effective and safer application, ultimately achieving the goal of reducing children's pain and accelerating postoperative recovery.

Key words: nerve block, ultrasound, children, expert consensus

中图分类号:

R614.4

超声引导儿童神经阻滞中国专家共识（2025版）编写组. 超声引导儿童神经阻滞中国专家共识（2025版）[J]. 上海交通大学学报（医学版）, 2025, 45(9): 1079-1098.

Writing Group of Chinese Expert Consensus on Ultrasound-Guided Pediatric Nerve Blocks in Children (2025 edition). Chinese expert consensus on ultrasound-guided nerve blocks in children (2025 edition)[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2025, 45(9): 1079-1098.

图/表 10

图1 儿童神经阻滞常用超声探头Note： A. 2.5 cm高频线阵探头(L型)/2.5 cm L-type high-frequency linear array probe. B. 2.5 cm高频线阵探头/2.5 cm high-frequency linear array probe. C. 3.5 cm高频线阵探头/3.5 cm high-frequency linear array probe. D. 低频凸阵探头/low-frequency convex array probe.

Fig 1 Ultrasound probes commonly used for nerve blocks in children

表1 超声引导儿童神经阻滞推荐方案的分级

Tab 1 Grading of recommended protocols for ultrasound-guided pediatric nerve blocks

阻滞区域

Block region

首选方案

Primary plan

升级方案

Advanced plan

上肢

Upper limb

肩部以下

Below shoulder

腋路臂丛阻滞

Axillary brachial plexus block

锁骨上臂丛阻滞、锁骨下臂丛阻滞

Supraclavicular brachial plexus block; infraclavicular brachial plexus block

肘部以下

Below elbow

肘平面阻滞

Elbow blocks

下肢

Lower limb

髋部

Hip

股神经阻滞

Femoral nerve block

髂筋膜阻滞、腰丛阻滞

Fascia iliaca block; lumbar plexus block

大腿及膝部

Thigh and knee

收肌管阻滞

Adductor canal block

膝下至足踝

Below knee

腘窝坐骨神经阻滞

Sciatic nerve block of popliteal fossa

踝部阻滞

Ankle block

躯干

Trunk

胸壁

Chest wall

尚无推荐

No recommendations

竖脊肌阻滞、椎旁阻滞、前锯肌平面阻滞

Erector spinae plane block; paravertebral block; serratus anterior plane block

腹部、腹股沟区

Abdomen,groin

腹直肌鞘阻滞、腰方肌外侧平面阻滞、阴茎背神经阻滞

Rectus sheath block; lateral quadratus lumborum block; dorsal penile nerve block

前路腰方肌阻滞、腹横肌平面阻滞、阴部神经阻滞

Anterior quadratus lumborum block; transversus abdominis plane block; pudendal nerve block

头颈部

Head and neck

颈前区

Anterior region of neck

颈浅丛阻滞

Superficial cervical plexus block

尚无推荐

No recommendations

耳

Ear

耳大神经阻滞

Great auricular nerve block

图2 腋路臂丛阻滞的超声定位和影像Note： A. 超声探头体表扫描定位/Surface scanning for ultrasound probe positioning. B. 探头处于图A位置时的腋路臂丛超声影像/Ultrasound image of the axillary brachial plexus obtained with the probe positioned as shown in figure A. a—腋动脉/axillary artery; b—尺神经/ulnar nerve; c—桡神经/radial nerve; d—正中神经/median nerve; e—肌皮神经/musculocutaneous nerve; f—肱二头肌/biceps brachii muscle; g—背阔肌大圆肌联合腱/the latissimus dorsi and teres major tendons; h—肱三头肌/triceps brachii muscle; i—喙肱肌/brachii muscle; j—肱骨/brachialis muscle.

Fig 2 Ultrasound positioning and imaging of the axillary brachial plexus block

图3 股神经阻滞的超声定位和影像Note： A. 超声探头体表扫描定位/Surface scanning for ultrasound probe positioning. B. 探头处于图A位置时的股神经超声影像/Ultrasound image of the femoral nerve obtained with the probe positioned as shown in figure A. a—股神经/femoral nerve; b—阔筋膜/fascia lata; c—髂筋膜/fascia iliac; d—股动脉/femoral artery; e—股静脉/femoral vein; f—髂腰肌/iliopsoas muscle.

Fig 3 Ultrasound positioning and imaging of the femoral nerve block

图4 腘窝坐骨神经阻滞的超声定位和影像Note： A. 超声探头体表扫描定位/Surface scanning for ultrasound probe positioning. B. 探头处于图A位置时的腘窝坐骨神经超声影像/Ultrasound image of the sciatic nerve in the popliteal fossa obtained with the probe positioned as shown in figure A. a—坐骨神经/sciatic nerve; b—股二头肌/biceps femoris muscle; c—半腱肌/semitendinosus muscle; d—半膜肌/semimembranosus muscle; e—腘动、静脉/popliteal artery and vein; f—股骨/femur.

Fig 4 Ultrasound positioning and imaging of the sciatic nerve block via the popliteal fossa

图5 腹直肌鞘阻滞的超声定位和影像Note： A. 超声探头体表扫描定位/Surface scanning for ultrasound probe positioning. B. 探头处于图A位置时的腹直肌鞘超声影像/Ultrasound image of the rectus sheath obtained with the probe positioned as shown in figure A. a—腹直肌后鞘/posterior sheath of rectus abdominis muscle; b—腹直肌/rectus abdominis muscle; c—腹腔/abdominal cavity.

Fig 5 Ultrasound positioning and imaging of the rectus sheath block

图6 腰方肌阻滞的超声定位和影像Note： A.超声探头体表扫描定位/Surface scanning for ultrasound probe positioning. B. 探头处于图A位置时的腰方肌超声影像/Ultrasound image of the quadratus lumborum obtained with the probe positioned as shown in figure A. a—腰大肌/psoas muscle; b—腰方肌/quadratus lumborum muscle; c—竖脊肌/quadratus lumborum muscle; d—腹肌/abdominal muscle; e—横突/transverse process; f—椎体/vertebral body; ① 腰方肌阻滞外侧点/needle insertion site for lateral quadratus lumborum block; ② 腰方肌阻滞后点/needle insertion site for posterior quadratus lumborum block; ③ 腰方肌阻滞前点/needle insertion site for anterior quadratus lumborum block.

Fig 6 Ultrasound positioning and imaging of the quadratus lumborum block

图7 颈浅丛阻滞的超声定位和影像Note： A. 超声探头体表扫描定位/Surface scanning for ultrasound probe positioning. B. 探头处于图A位置时的颈浅丛超声影像/Ultrasound image of the superficial cervical plexus obtained with the probe positioned as shown in figure A. a—颈浅丛/superficial cervical plexus; b—颈深筋膜/deep cervical fascia; c—胸锁乳突肌/sternocleidomastoid muscle; d—C5神经根/C5-nerve root.

Fig 7 Ultrasound positioning and imaging of the superficial cervical plexus block

表2 常用局麻药的推荐剂量［84］

Tab 2 Recommended dosages of common local anaesthetics［84］

局麻药

Local anaesthetics

最大剂量/(mg·kg^-1)

Maximum allowable

dose/(mg·kg^-1)

外周神经和躯干阻滞单次推注

Bolus for peripheral and truncal block

连续阻滞持续推注

Infusion for continuous block

质量浓度/[g·(100 mL)^-1]

Mass concentration/

[g·(100 mL)^-1]

容量/(mg·kg^-1)

Volume/(mg·kg^-1)

质量浓度/[g·(100 mL)^-1]

Mass concentration/

[g·(100 mL)^-1]

速率/[mg·(kg·h)^-1]

Rate/[mg·(kg·h)^-1]

罗哌卡因

Ropivacaine

左旋布比卡因

Levobupivacaine

表3 常用儿童神经阻滞的适应证及局麻药的推荐剂量［41］

Tab 3 Indications and recommended local anaesthetic doses for common pediatric nerve blocks［41］

常用神经阻滞方法

Common nerve block technique

适应证

Indication

0.2%罗哌卡因

0.2% Ropivacaine

腋路臂丛阻滞

Axillary brachial plexus block

肘切开复位内固定、前臂和手外科手术

Elbow open reduction and internal fixation; forearm and hand surgery

0.2‒0.5 mL·kg^-1 (最多15 mL/up to 15 mL)

股神经阻滞

Femoral nerve block

股骨骨折、股骨上段骨骺滑脱、股骨截骨术

Femoral fracture; slipped upper femoral epiphysis; femoral osteotomy

0.2‒0.5 mL·kg^-1 (最多15 mL/up to 15 mL)

腘窝坐骨神经阻滞

Popliteal sciatic nerve block

肌腱转移/延长、下肢创伤、胫骨截骨术、踝关节成形术、畸形足修复

Tendon transfers/lengthening; lower limb trauma; tibial osteotomy; ankle arthroplasty; club foot repair

0.2‒0.3 mL·kg^-1 (最多15 mL/up to 15 mL)

腹直肌鞘阻滞

Rectus sheath block

脐疝修补术、幽门环肌切开术、开放性胃造口术

Umbilical herniotomy; pyloromyotomy; open gastrostomy

0.1‒0.3 mL·kg^-1 (单侧/per side)

外侧腰方肌入路阻滞

Lateral quadratus lumborum block

腹股沟疝修补术、开放性阑尾切除术

Inguinalherniotomy; open appendicectomy

0.5 mL·kg^-1 (单侧最多20 mL/up to 20 mL per side)

阴茎背神经阻滞

Dorsal penile nerve block

包皮环切术、远端尿道下裂修复术

Circumcision; distal hypospadias repair

0.1 mL·kg^-1 (双侧最多5 mL/up to 5 mL both sides)

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