Kungani i-Plexus Stimulation Needle ibalulekile kuzo zizindlela zokublocka amaphakathi?

Isikhombisa Sembili SePlexus Sijabeka Ukubhekisa Ngokushesha Nokuhlanganisa Amaphakathi Ngokushesha

Izinkotho Zokubhekisa Ngokusebenzisa Umthelela: Ukuguqula Isiphambano Somphumela Wokusebenza KuMpendulo Oyinhloko Yokubhekisa

Ukusebenza kwelektrolokesheni kufuna ukuthumela imitha yamandla (ngokwesibonelo, ngaphezu kwe-0.2 ku-0.5 milliamps) ngendlela ethile yendawo eyaziwa ngokuthi yi-plexus stimulator. Uma lokhu kwenza ngezinsizakalo, amakhono aya kubhala — isibonelo, sibona okwesibonelo ukuthi indawo yokuqala yamakhono ayabhalisa ngokuphambuka kwemiphakathi yezindawo zokugcina (lumbar block procedures). Lezi zibhaliso zemakhono zinikela abadokotela izimboni ezinkulu ezibonisa ukuthi bafika ekuhlakweni kokuphambuka kwesikhundla sakho kabefore ukuthi baphinde baphakamise amandla. Ngaphandle kokuvavanya ukuthi indawo iphakade njani ngokubhekana namaningi kuphela, le tekniki yelektrolokesheni ibuyisela lezi zinyathelo zokuhlanganisa izinyathelo zokuzwa noma ukubona. Amaphuzu abonisa ukuthi uma besebenzisa le tekniki, ukuphakamisa amandla kwenza ngokukhululeka ngokwesibonelo ngokuphambuka kwesibonelo ngokuphambuka kwesibonelo ngokuphambuka kwesibonelo ngokuphambuka kwesibonelo ngokuphambuka kwesibonelo ngokuphambuka kwesibonelo ngokuphambuka kwesibonelo ngokuphambuka kwesibonelo ngokuphambuka kwesibonelo ngokuphambuka kwesibonelo ngokuphambuka kwesibonelo ngokuphambuka kwesibonelo ngokuphambuka kwesibonelo ngokuphambuka kwesibonelo ngokuphambuka kwesibonelo ngokuphambuka kwesibonelo ngokuphambuka kwesibonelo ngokuphambuka kwesibonelo ngokuphambuka kwesibonelo ngokuphambuka kwesibonelo ngokuphambuka kwesibonelo ngokuphambuka kwesibonelo ngokuphambuka kwesibonelo ngokuphambuka kwesibonelo ngokuphambuka kwesibonelo ngokuphambuka kwesibonelo ngokuphambuka kwesibonelo ngokuphambuka kwesibonelo ngokuphambuka kwesibonelo ngokuphambuka kwesibonelo ngokuphambuka kwesibonelo ngokuphambuka kwesibonelo ngokuphambuka kwesibonelo ngokuphambuka kwesibonelo ngokuphambuka kwesibonelo ngokuphambuka kwesibonelo ngokuphambuka kwesibonelo ngokuphambuka kwesibonelo ngokuphambuka kwesibonelo ngokuphambuka kwesibonelo ngokuphambuka kwesibonelo ngokuphambuka kwesibonelo ngokuphambuka kwesibonelo ngokuphambuka kwesibonelo ngokuphambuka kwesibonelo ngokuphambuka kwesibonelo ngok......

Ukuthiwe kwe-shaft esithunywa: Ukuvumela ukuthumela kwamandla ngokuphambuka kwezindawo futhi ukulahla iziphakamiso ezingavumelekile

Isikhumba sesihlangothi esisifundisa ngokuphelele sikhuthaza umoya wokushisha ukuthi usebenze kuphela kusihlangothi sokushisha esibonakalayo, okufanana nomdlwengwe wamanje amilimita eyodwa noma kancane kunele. Lokhu kuhlupha umoya wokushisha ukuthi kusale kusindawo esizimele. Isimo sokubhekana kwenza ukuthi kubhekane kusindawo esincane kakhulu, okufanana nomdlwengwe wamanje amilimita eyodwa noma kabili. Uma lokhu kahle kwenza, iziphumo zokusebenzisa isihlangothi zibonisa ngokucophelela ukuthi isihlangothi sisekude kanjani kumazwi, emanzini kungafani nokuthola izimpendulo kusindawo esingaphansi kwezinye noma kusindawo esingasendleleni. Ngokubhekana kwalokho, abadokotela bavona izimpendulo ezingafanele ezincane kakhulu uma kubhekana kumazwi abangayithemba. Kanti ukuthola kwezinye izinto ezibalulekile kusindawo esizimele, njengezinkambo zomoya, kuhlela kakhulu futhi. Izinsiza zezincwadi zokufunda eziqondiswayo kwi-Anesthesia & Analgesia zikuvuma lokhu, zibonisa ukuthi kukhula ngokuphelele ngokuphakeme kwe-41% kwezinye izimpendulo ezingafanele.

Ukwenzeka Kwesifundo Sokubhekana Kwezimpilo Kusukela Ekubhekana Kwezimpilo Kusindawo Yesiphalo

Izivinini Zokuphumelela Kwanqoba: Isihlangothi Sokubhekana vs. Ukubhekana Kwegama Lokuqala

Ukuhlanganisa inaliti yokukhuthaza i-plexus nobuchwepheshe be-ultrasound empeleni kwandisa izinga lokuphumelela kokuqala kwe-brachial plexus blocks phakathi kuka-15 no-20% uma kuqhathaniswa nokusebenzisa i-ultrasound yodwa. Umklamo wokucwaninga osanda kwenziwa wezikhungo eziningi wathola ukuthi amaphesenti angu-88 alawo mabhulokhi anzima ase-supraclavicular akwazi ukusabalalisa kahle i-anesthetic lapho nje ezama okokuqala lapho odokotela besebenzisa ukubuyekezwa kokuma kwe-electrolocation ngesikhathi senqubo. Yonke le nqubo iba bushelelezi kakhulu. Odokotela akudingeki baqhubeke behambisa inaliti njalo, okusika isikhathi esivamile esidingekayo ukuze kwenziwe inqubo ngemizuzu engaba yisikhombisa. Iziguli zibika nokuthi zizwa ukungakhululeki okuncane kakhulu, zibeka ubuhlungu bazo isilinganiso esingu-2. 3 esikalini esifana nesokubukwa uma kuqhathaniswa no - 4.1 ngaphandle kwaleli thuluzi. Le miphumela ibonisa ngokucacile ukuthi kungani ochwepheshe abaningi bezokwelapha sebeqala ukukhetha le ndlela yokuhlanganisa kokubili ukuthi isebenza kahle kangakanani emtholampilo nangokuthi iziguli ngokuvamile ziyibekezelela kangcono.

Amathreshholdi Okuphendula Kwemotori (0.2–0.5 mA) njengezindlela eziphelele zokubonisa ukuthi ublock uyadlula futhi ukuthi ubuyisiphi isikhathi

Ukuphendula kwemotori okuphakathi kwezinsuku ziyasandlisa ngokukhulu ukusebenza kahle kweblock. Idata esitholwe ku-2023 kusukela emfanekiseni yezibhalo ziyabonisa ukuthi ukusimulatha kulesi sikhundla kuyalungana nokuthi ukuphendula kwe-sensory kuyadlula kusho, isikhathi sokudlula kuyadele, futhi ukuphumelela kwezindlela ziyakhulu:

Ukusimulatha kuleli sikhundla (≤0.5 mA) kubonisa ukuthi inedhile iyaphakamisa ngokuphelele nesinye sesinye, kuyadlula ukuphendula kwe-sensory ngama-40% futhi kugcina ivolyumi yelokhu lokufaka amasimbi ngama-25%—ngaphandle kokuthi kuhlelwe isikhathi sokunquma.

Ukuvuselela Umsebenzi: Ukugxilisa Injekthi Yokuchitha KwePlexus Ngezinhlanganisi Zokuchitha Nezinye Ezintsha

Lapho injekthi yokuchitha kweplexus iphatha ngokuhambisana nezinhlanganisi zokuchitha zezinsukwane, kuyibeka kabusha indlela yokwenza ukuchitha kwezindawo, futhi kuyenza umsebenzi wonke ubuhle obungcono futhi obunamandla. Lesi sistimu sena isici sokulungiswa okuphelele sokufakwa kwesikhombisa nokuthumela kwesikhombisa. Lokhu kuthabatha ukuthi abadokotela bangayisiza amandla okuchitha ngokucacile ngaphandle kokuzama nokubona njengoba bakhathazekile ngaphambi. Kubadokotela, lokhu kuthabatha ukuthi bafunde izinyawo ngokuphelele njengalokho, okukhula isikhathi sokwenza izindlela futhi kususa isibindi sokufunda isikhathi sokwenza izindlela. Izindlela zokuziphatha ezintsha zokusebenzisa izihlanu noma kuphela ukubonisa ngokuphelele kungasiza loku kubuhle nokuspeed.

Imigomo Yokuhambisana: Ukuxhasa Iziphakamiso Zesikhombisa Nokuthumela Kwesikhombisa (Isilinganiso Se-2–5 mA)

Ukuze kufanele kube nesikhundla esihle kufuneka kubekho ukulandana phakathi kwezinkqubo zokwenza izikhumba nezinkqubo zokuthiwa izinkampani. Izikhumba ezwenziwe ukusetyenziswa kwezinkampani zokusebenza ngokuzimisa kwisilingo sesi-2–5 mA zinamathuba okwenziwa njengoko landelayo:

• Ubukhulu bezinkokhelo zokugcina ubukhulu be-0.1–0.3 mm ukuze kungabhekwe umoya wokuthiwa emazini angalungileyo
• Amaphuzu amahle ayezinye amakhanda okuthiwa azifana nezinkampani, abanenani elingaphezu kwe-1 mm, akusiza ekutheni kwezinkampani ngokuzimisa kwezinkinga ezincinci njengoko kuyi-0.2 mA
• Amakhanda amancane okuthiwa okwesibhakabhaka okunciphisa umkhondo wokuthiwa—nangona isikhumba sisebenza kwezindawo eziphakeme kwezindawo zezikhuba zokuthiwa

Ukulingana kwezinkampani kuchaza umkhondo wokuthiwa okungafanele noma ukuthiwa kwezindawo zokuthiwa. Amaphupho ayasho ukuthi ukulandana kwezinkampani kunciphisa isikhathi sokuguqula umkhondo ngama-40%, nakho amaphupho okuthiwa okuthiwa kwezinkampani ezintsha ayasiza ekutheni kwezinkampani ngokuzimisa ngokuzimisa kwezinkampani ngokuzimisa kwezinkampani.

Amathuba Okuzimisa Ngokwesikhundla Kwezindawo Ezinkulu Zokuthiwa

Isikhundla Sokuthiwa Kwesikhundla: Ukuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kwesikhundla Sokuthiwa Kw......

Kukhuluma kwemilingo yase-lumbar, ukuthi kubonakale umthwalo wemisilwa yase-quadriceps ngemiphakathi ya-0.2 ku-0.5 milliamps kuyabona ukuthi isikhombisa sisekhethekile kahle emuva kwezinye zemilingo ya-L2 kuya ku-L4. Lokhu kusilwa kusekho kuthiwa kakhulu njengokuchaza okuphelele ukuthi lokhu kuzosindiswa kahle. Kungani? Kukho izifundo ezibonisa ukuthi ngemiphakathi ya-95 kwe-100 emva kokubona lokhu kusilwa, abantu bafuna ukugcina okuphelele kwezinye zemilingo. Ngaphezu kwalokho, amadokotela angathatha inzuzo yezinkambo zokugcina ngemiphakathi ya-30 percent ngaphandle kokuthi kuhleleke ukusebenza kahle. Lokhu kusilwa okuphelele kusho ukuthi kunezidingo ezingaphansi yokugcina imilingo yase-femoral ngokungafanelekile ngokufaka, futhi ukusebenza kuyavuka kahle kunezindlela ezingaphansi. Abaprofesiwoni abanamandla kakhulu baxolisa ukuthi lokhu kusilwa kuyisimo esihle kakhulu sokubona ukuthi konke kwenziwe kahle kulezi zinhlobo zemilingo yezinye.

Brachial Plexus: Iziprothokholi Zokuxhumana Ngqondweni Kwemilingo Yase-Axillary Nokwesupraclavicular

Izinhlelo zokuvulwa kufanele zihambisane ngezinhlelo zokubalwa kwe-anatomy futhi nezinhlelo zokuhlukana ngokwesikhundla esithile sokugcina umuntu. Uma sibeka amasiko ase-axillary, sibona izindlela zokuhamba ezinkulu njengezinye zezincwadi zokuzwela noma ukuzwela kwemphakathi yezincwadi uma sisebenzisa amandla phakathi kwe-0.3 kanye ne-0.8 mA. Lezi zimpendulo zizibonisa ukuthi sibekhona ebusweni besinamandla ka-median noma ka-ulnar. Uma sibeka amasiko ase-supraclavicular, uma umuntu ubona ukuzwela kwe-diaphragm noma emaphakathi yezincwadi zokuphepha kusuka ku-0.5 mA, lokhu kusho ukuthi asikho isibonelo sokuthi sibekhona esinamandla ka-phrenic. Kodwa khumbula ukubheka izivale ezini ku-0.2 mA uma sibeka amasiko ase-interscalene, ngoba lokhu kuyenza ukuthi kungabi nempilo yokubeka ngqo esinamandla. Amaphayipi ase-Regional Anesthesia and Pain Medicine ase-2023 abonisa ukuthi uma sisebenzisa lezi zinhlelo zokubalwa zizokunciphisa ukubhekwa kwamaphakathi yezincwadi ngeminyaka engu-40%. Lokhu kuyakwaziwa kahle, ngoba uma sisebenzisa lezi zinhlelo zokubalwa kuyenzeka ukuthi kubhekwe okuhle ngokujwayelekile nokuncipha kwezinkinga ezizayo.

Imibuzo Evame Ukubuzwa

Ukuthi kuyini indlela eyamandla yokusebenzisa isikhombisa sokubhala isikhombisa?

Indlela eyamandla yilokuba kubhekwa ngokuphelele kwezinhlobo zezinyawo, futhi lokhu kuvumela ukuthi izikhombisa zezinyawo zizofika kwezinkinga kahle kanye nokunciphisa ukuzwisisa kwabantu.

Ukuthi ukugcina kwenqubo yesikhombisa kusiza kanjani?

Ukugcina kuvumela ukuthi umoya wokubhala usebenza kuphela emaphakathini esikhombisa, futhi lokhu kunciphisa iziphetho ezingafanele kanye nokunciphisa ukuthi izinyawo ezingenalo ukuthi zisebenze zizobhala.

Ngaba isikhombisa sokubhala isikhombisa singasebenziswa nge-ultrasound?

Yebo, ukudibanisa isikhombisa sokubhala isikhombisa ne-ultrasound kungakhulisa kahle ukuthi izikhombisa zezinyawo zizofika kwezinkinga kahle kanye nokuphela kwezinkinga kahle.

Izindlela zokubhala zezinyawo zezimali ziyini?

Kunezinkinga eziningi, ukuthi ubhala okuphelele kwezinyawo kufanele kube phakathi kwe-0.2 kunye ne-0.5 mA ukuthi kuvumeleke ukuthi izikhombisa zezinyawo zizofika kwezinkinga kahle.