Ukuqonda Imifanekiso Yemithwalo Yokuphuma

Imiphumela Emihle Yomthwalo Wakuphuma: Umkhakha, Isihlalo, Nemisebenzi Yomthwalo Wakuphuma

Ukuphuma Ngokuphuma Noma Ngokuphuma Ngokungafanele (Ngokuphuma Kwezincwadi) Futhi Umphumela Wokuphuma Kwesiqu

Ukubeka kwe-Quincke needles kuyisibonelo sokukhupha izihlangothi zomzimba, okuyikhubaza amasiko ayezihlangothi zomzimba nokufuya kwamafliwidi wokugcina isifuba (cerebrospinal fluid) kusukela ku-25% ukuze ku-40% ngokulinganisa nezinye iindawo ezingakukhuphi ngokuchazwa ngu-Anesthesiology ngo-2022. Ngaphakathi kwalokho, izihlangothi zomgca (pencil point) njenge-Whitacre noma Sprotte zisebenza ngendlela eyahlukileyo ngokuthi ziyabulala izihlangothi zomzimba ngokungakhuphi, kodwa ziyabulala zizihlangothi zomzimba ngokuzihlukanisa. Lokhu kwenza amasiko athi ayasebenza ngokuzihlukanisa, okuyikhubaza ukusebenza kwezihlangothi zomzimba ngokuzihlukanisa, okuyikhubaza ukusebenza kwezihlangothi zomzimba ngokuzihlukanisa, okuyikhubaza ukusebenza kwezihlangothi zomzimba ngokuzihlukanisa, okuyikhubaza ukusebenza kwezihlangothi zomzimba ngokuzihlukanisa, okuyikhubaza ukusebenza kwezihlangothi zomzimba ngokuzihlukanisa, okuyikhubaza ukusebenza kwezihlangothi zomzimba ngokuzihlukanisa, okuyikhubaza ukusebenza kwezihlangothi zomzimba ngokuzihlukanisa, okuyikhubaza ukusebenza kwezihlangothi zomzimba ngokuzihlukanisa, okuyikhubaza ukusebenza kwezihlangothi zomzimba ngokuzihlukanisa, okuyikhubaza ukusebenza kwezihlangothi zomzimba ngokuzihlukanisa, okuyikhubaza ukusebenza kwezihlangothi zomzimba ngokuzihlukanisa, okuyikhubaza ukusebenza kwezihlangothi zomzimba ngokuzihlukanisa, okuyikhubaza ukusebenza kwezihlangothi zomzimba ngokuzihlukanisa, okuyikhubaza ukusebenza kwezihlangothi zomzimba ngokuzihlukanisa, okuyikhubaza ukusebenza kwezihlangothi zomzimba ngokuzihlukanisa, okuyikhubaza ukusebenza kwezihlangothi zomzimba ngokuzihlukanisa, okuyikhubaza ukusebenza kwezihlangothi zomzimba ngokuzihlukanisa, okuyikhubaza......

Isibonelo sokubulala, Amasiko okugcina isifuba, nokuthintana kwezihlangothi zomzimba ukusebenza ngokuphelele

Amahlango kwe-bevel okuyisikhathi esiphakathi kwezinkambo zeminyaka ezingu-15 kuya kwezinkambo zeminyaka ezingu-30 ziyasebenza ngokuphelele ukuthola ubude bakwesifunda sokufakwa kwesifunda ngokulingana nokuthi ubude bethu bekuphambuka kanjani. Lokhu kubalulekile kakhulu ukuthi kubaluleke ukuthi kwenziwe ngokukhawuleza futhi kubaluleke ukuthi kubhekwe ngokuphelele ukuthi kuzobhekwa ngokuphelele ukuthi kuzobhekwa ngokuphelele ukuthi kuzobhekwa ngokuphelele ukuthi kuzobhekwa ngokuphelele ukuthi kuzobhekwa ngokuphelele ukuthi kuzobhekwa ngokuphelele ukuthi kuzobhekwa ngokuphelele ukuthi kuzobhekwa ngokuphelele ukuthi kuzobhekwa ngokuphelele ukuthi kuzobhekwa ngokuphelele ukuthi kuzobhekwa ngokuphelele ukuthi kuzobhekwa ngokuphelele ukuthi kuzobhekwa ngokuphelele ukuthi kuzobhekwa ngokuphelele ukuthi kuzobhekwa ngokuphelele ukuthi kuzobhekwa ngokuphelele ukuthi kuzobhekwa ngokuphelele ukuthi kuzobhekwa ngokuphelele ukuthi kuzobhekwa ngokuphelele ukuthi kuzobhekwa ngokuphelele ukuthi kuzobhekwa ngokuphelele ukuthi kuzobhekwa ngokuphelele ukuthi kuzobhekwa ngokuphelele ukuthi kuzobhekwa ngokuphelele ukuthi kuzobhekwa ngokuphelele ukuthi kuzobhekwa ngokuphelele ukuthi kuzobhekwa ngokuphelele ukuthi kuzobhekwa ngokuphelele ukuthi kuzobhekwa ngokuphelele ukuthi kuzobhekwa ngokuphelele ukuthi kuzobhekwa ngokuphelele ukuthi kuzobhekwa ngokuphelele ukuthi kuzobhekwa ngokuphelele ukuthi kuzobhekwa ngokuphelele ukuthi kuzobhekwa ngokuphelele ukuthi kuzobhekwa ngokuphelele ukuthi......

Ukusebenza kwe-Stylet, Ukulungiseka kwe-Hub, nokuthembekile kwe-Steering yendawo yendumbu ngokushesha

Indumbu yokuqala iyasebenza izinto ezimbili ezingaphambili ekupheleni kwazo kuziphakamiso: ikhupha ukuthi amasela ayikoreke xa kufakwa izinkampani, futhi ikhupha indawo yendumbu isivumelwane kuze kufike umsila wokukhupha okanye amasela okuhlanganisa. Uma i-hub ne-stylet zilungisekwe kahle, akukho phakade eshiywa phakathi kohlobo lwe-stylet nendumbu iphuma khona. Lokhu kuthabatha ukuthi abadokotela bafuna ukuthi bakhangele ngamanqaku abo, lokhu kwenza konke kubhekise kahle ngokushesha xa bapheka. Ngezikhathi zokubonisa ngokushesha, ukuzinga indumbu kusiza abasosayensi ukwenza izigcino ezincinci zokuguqula indlela, ngokuvamile kungenani kwe-halves millimeter. Lokho kukhulu kakhulu uma kufakwa indumbu yamasela noma kufakwa okunye okuphambili kokuthi ukuthembekile kwezindawo zokugcina kuyisisekelo sokuphambili.

Izinkinga Zokuhlukanisa Kwezinhloso Zokudesign

Ukuchazi Kwamaphakamiso Amakhulu Okuphakama: Quincke, Whitacre, kanye ne-Sprotte

Izilingo zokuphakama kwe-CSF nezilingo zokuphakama kwezihlalo (PDPH) ngokwezifunda zokuphakama

Umbala wezinyawo zokuphakama kuyisisekelo esikhulu uma kufundwa ukuthi kungaphi ukuthi kubhekwa ukuthi kungaphi ukuthi kubhekwa ukuthi kungaphi ukuthi kubhekwa ukuthi kungaphi ukuthi kubhekwa ukuthi kungaphi ukuthi kubhekwa ukuthi kungaphi ukuthi kubhekwa ukuthi kungaphi ukuthi kubhekwa ukuthi kungaphi ukuthi kubhekwa ukuthi kungaphi ukuthi kubhekwa ukuthi kungaphi ukuthi kubhekwa ukuthi kungaphi ukuthi kubhekwa ukuthi kungaphi ukuthi kubhekwa ukuthi kungaphi ukuthi kubhekwa ukuthi kungaphi ukuthi kubhekwa ukuthi kungaphi ukuthi kubhekwa ukuthi kungaphi ukuthi kubhekwa ukuthi kungaphi ukuthi kubhekwa ukuthi kungaphi ukuthi kubhekwa ukuthi kungaphi ukuthi kubhekwa ukuthi kungaphi ukuthi kubhekwa ukuthi kungaphi ukuthi kubhekwa ukuthi kungaphi ukuthi kubhekwa ukuthi kungaphi ukuthi kubhekwa ukuthi kungaphi ukuthi kubhekwa ukuthi kungaphi ukuthi kubhekwa ukuthi kungaphi ukuthi kubhekwa ukuthi kungaphi ukuthi kubhekwa ukuthi kungaphi ukuthi kubhekwa ukuthi kungaphi ukuthi kubhekwa ukuthi kungaphi ukuthi kubhekwa ukuthi kungaphi ukuthi kubhekwa ukuthi kungaphi ukuthi kubhekwa ukuthi kungaphi ukuthi kubhekwa ukuthi kungaphi ukuthi kubhekwa ukuthi kungaphi ukuthi kubhekwa ukuthi kungaphi ukuthi kubhekwa ukuthi kungaphi uk......

Ukuqondwa kwe-ultrasound nokubonakaliswa kwemithambo yokuqonda kuhlanganiswa ngokwesilinganiso

Ukuqondwa kwezindlela zokubhala nokubonakaliswa kwebhodi yomsebenzisi kuhlanganiswa ngokwesilinganiso phakathi kwezinhlobo zezikhumba:

• Quincke : Kukhomba ukubonakaliswa okuphelele kwezikhumba ngokugcina umkhakha wokudlula kwe-dura, kodwa kusondeza izinkumbu zesi-ultrasound ngokwesikhombisa sakho sesikhumba sokuzihlukanisa, okuvumela ukubonakaliswa kwezinsuku zokusebenza.
• Whitacre : Kukhomba ukubonakaliswa okuphelele kwe-ultrasound nokubonakaliswa okuphelele kwezikhumba—kufanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi k......
• Sprotte : Kunezinkumbu zokubonakaliswa kwe-ultrasound ezihlelwe ngokuphelele nezikhumba zokugcina ezihlelwe ngokuphelele, okukhomba ukubonakaliswa kwe-ultrasound okuphelele, kodwa ukuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe njengokuthi kungafanele kubhekwe......

Ukukhetha isikhombisa esihle sokuqala sibuyisela ubungakanani bokwenza: amaphrofayela asho ukuthi kukhona ukuphepha kwe-30% kwamathuba okufaka uma isikhombisa sifanana nezindlela zokubonwa ngokusebenzisa i-ultrasound nokwazi kwe-mbhalali.

Ukukhetha isikhombisa sokufaka ngokusebenzisa izindlela ezitholakala ngokwemboni kwezindlela zokuziphatha kwezincwadi zezempilo

Ukufaka emhlabathini wasezansi nokufaka kwe-spinal anesthesia: iziqondiso zokufaka ngokulinganisa isikhombisa–ubude–isikhombisa sesihlango

Umbuso wemithambo yezempilo ubhekiswe kakhulu ukuthi izikhumba zokubhala zokungahloniphi ziyisifundo esiphakeme kuzo zonke izindlela zokuphuma kwemithambo yelumbari nezindlela zokuhlanya imithambo. Izifundo zesayensi zibonisa ukuthi lezi zikhumba zikhipha izihlukanisi zokuphuma kwemithambo ngokuphakeme kwezinye izikhumba zokufunda uQuincke ngokuphakeme kwezinye izikhumba ngokuphakeme kwezinye izikhumba ngokuphakeme kwezinye izikhumba ngokuphakeme kwezinye izikhumba ngokuphakeme kwezinye izikhumba ngokuphakeme kwezinye izikhumba ngokuphakeme kwezinye izikhumba ngokuphakeme kwezinye izikhumba ngokuphakeme kwezinye izikhumba ngokuphakeme kwezinye izikhumba ngokuphakeme kwezinye izikhumba ngokuphakeme kwezinye izikhumba ngokuphakeme kwezinye izikhumba ngokuphakeme kwezinye izikhumba ngokuphakeme kwezinye izikhumba ngokuphakeme kwezinye izikhumba ngokuphakeme kwezinye izikhumba ngokuphakeme kwezinye izikhumba ngokuphakeme kwezinye izikhumba ngokuphakeme kwezinye izikhumba ngokuphakeme kwezinye izikhumba ngokuphakeme kwezinye izikhumba ngokuphakeme kwezinye izikhumba ngokuphakeme kwezinye izikhumba ngokuphakeme kwezinye izikhumba ngokuphakeme kwezinye izikhumba ngokuphakeme kwezinye izikhumba ngokuphakeme kwezinye izikhumba ngokuphakeme kwezinye izikhumba ngokuphakeme kwezinye izikhumba ngokuphakeme kwezinye izikhumba ngokuphakeme kwezinye izikhumba ngokuphakeme kwezinye izikhumba ngokuphakeme kwezinye izikhumba ngokuphakeme kwezinye izikhumba ngokuphakeme kwezinye izikhumba ngokuphakeme kwe......

Amasevisi amahle: ukususa ama-ooocyte, isikhumba sesifunda sokuphakamisa isifunda, nokubhlokisela amasweli

Amasevisi amahle ayetshela ukusebenzisa izinkotho ezihlelwe ngokuphelele:

• Ukususa ama-ooocyte : Usebenzisa izinjongo zezingu-17G–19G nezincwadi zokubonwa kwe-ultrasound nezindawo zokuphakama ukuthi zibe nesikhathi sobude ngokubonwa kwe-ultrasound ngokuphakama kwe-follicular ngokwesibhakabhaka.
• Isikhumba sesifunda sokuphakamisa isifunda : Kufuneka kusebenziswe izinjongo zezingu-18G zesi-Tuohy nezincwadi zokubonwa kwezindawo zokuphakama nezinjongo ezikhethekile ezizungu ukuthi zithumele isifunda esiphakathi kwesifunda ngokuphakama ngokuphelele futhi ukuthintele ukuthi kuzwale amasweli.
• Ukubhlokisela amasweli angaphandle : Kuyasebenzisa izinjongo zezingu-22G–25G ezingaphansi kwezindawo zokuphakama, nezinjongo ezizungu okuhlelwe ngokuphelele ukuthi zibe nesikhathi sobude ngokubonwa kwe-ultrasound nokuthintela ukuthi kuzwale amasweli amahle.

Ukukhetha izinjongo ezihlelwe ngokuphelele kulezi zinhlobo zokusebenza kunciphisa amaphroblemi okusebenza—kungakhathaliseki kwezifunda, ukuthintela kwezamasweli, nokungafanele kwezibhlokisi—ngu-30–45% kulokho okukhona kwezinkotho zokusebenza ngokujwayelekile noma kwezinkotho ezingahambani, ngokwemibhalo yezinkotho zokusebenza zokugcina.

Imibuzo Evame Ukubuzwa

Yini inkulu yokuvamile kwezinjongo zokubhala ngaphezu kwezinjongo zokuthatha?

Izikhali zokubhala, njengezikhali zikaWhitacre noma zikaSprotte, zizimisa kakhulu ukuthi kubhekwe izihlalo zokuphakama kwemphakathi (PDPH) ngokukhulula izihlalo zemphakathi ngaphandle kokuthi zibhalele.

Kungani ubude bevel nezinhlobo zokuphakama kwezikhali zibalulekile ekubeni ziyakhiwa?

Ubude bevel nezinhlobo zokuphakama kwezikhali zikuthinta ukufinyelela kwezinhlobo, ukudireka kweprojekthi, nokuhlela kwezinhlobo. Izingxenye phakathi kwe-15–30 degrees ziyakwenza lezi zinhlobo zibe yinkimbinkimbi.

Ukuboniswa kwe-ultrasound kuyakwenza ukuthi ukubeka kwesikhali kube mnyanisekile njani?

Ukuboniswa kwe-ultrasound kuyakwenzeka ukuthi kubhekwe ukuthi kusebenza kahle ngokubona ngokushesha kanye nokudireka okuphelele wokubeka, kuyakwenzeka ukuthi kubhekwe ukuthi kubeka kancane futhi kubhekwe ukuthi kunezinkinga zeprojekthi.

Izikhali zingaphi eziphelele kakhulu ukubeka kwe-lumbar puncture ne-spinal anesthesia?

Izikhali zokuvikela izinhlobo zokubhala zokubhala ziyasebenzisa kakhulu ukubeka kwe-lumbar puncture ne-spinal anesthesia ngoba zinamandla okuthi akubhekwe izihlalo zokuphakama kwemphakathi (PDPH) noma ukuthi kususwa kwe-CSF.

Izikhali zingaphi ezispecialized ezisebenziswa ukususa amasperm?

Ukukhupha ama-ovum kusebenzisa amaphutha angama-17G–19G ene-echogenic coatings nezikhathi zokugcina ngokujulile ukuze kubhekwe ngokucophelela kwe-ultrasound ngokugcina kwe-follicular aspiration yase-transvaginal.