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

Isisekelo seNeurophysiological: Indlela eya kusetshenziswa ngayo yezikhali zokuvuselela kweplexus yokubhekana nemithambo yezinhloso ukuze kwenziwe ukubhekana kwe-nerve ngokuphelele

Kungani isivinini sokuphuma kwemithambo yezinhloso engu-0.3–0.5 mA siyatholakala njengesibonelo esivumelwayo sokubhekana kwezikhali no-nerve

Abaprofesiwe bendawo bafunda ngokujulile ukuthi indawo engaphakeme yokuqondisa indawo yamaphakathi emithwalo yezinye zokufaka amasonto kusuka ku-0.3 ku-0.5 milliamps. Izifundo zokubheka imiphumela yezindlu zokuphuma kubonisa ukuthi lapha izikhombisa ziyaphakama kule nqanawa yesikhathi, zingaba zingu-1 ku-2 millimeters ngaphezulu kwezinye zokufaka amasonto. Lokhu kubalulekile ukuthi umthwalo uzofuna kakhulu kodwa akuzange wafake ngqo kwezinye zokufaka amasonto. Umgomo wekuqondisa lokhu kuyisibonelo sokuthi izinye zokufaka amasonto ziyasebenza njani ngokusebenza kwezinye zokufaka amasonto. Izinye zokufaka amasonto ezinkulu (ezizigaba ze-A alpha/beta) zidinga amandla angaphezu kwezinye zokufaka amasonto ezincane ozokuthi ziyabhekisa izimilo zokuphuma kwezinye zokufaka amasonto ozokuthi ziyabhekisa izimilo zokuphuma kwezinye zokufaka amasonto. Lapha abadokotela bakhala amandla kungaphezu kwe-0.5 mA, bafunda indawo yezinye zokufaka amasonto ngaphandle kokukhala izimilo zokuphuma zezinye zokufaka amasonto ozokuthi ziyabhekisa izimilo zokuphuma kwezinye zokufaka amasonto. Izifundo zibonisa ukuthi lapha sikhala lezinye zokufaka amasonto ezingcwele, kususa izindleko zokufika kwesibili ngokugcwele ngokuphakeme kwezinye zokufaka amasonto ozokuthi ziyabhekisa izimilo zokuphuma kwezinye zokufaka amasonto.

Umsebenzi wemifibhile yomoto we-Aα/β engezwe ngemvubuko ekwenzeni kwezikhathi zokubuka ngokuphelele, ngokwesikhathi sokugcina, uma kuthathwa indawo yendumbi yokukhanya kwisikhathi sokuzama ukukhanya isikhombisa

Izifibhile zokuhamba kwe-motor eziyisinye nge-myelin zinamandla njengamandla aseNtando. Lezi zifibhile zinezindawo ezinkulu kakhulu ezihambisana kusukela ku-12 ku-20 micrometers futhi zizwele ngamaphakathi amaningi we-myelin okuyinto ekuvumela ukuthi izimpendulo zihambise kusheshwe kakhulu, ngokwesibonelo ku-80 ku-120 meters ngosekondi. Lokhu kulandela ukuthi bafuna kwanasekuqala lapha kubhekwa emikro-khurenti. Njengoba isikhombisa sokuhamba kwe-plexus sibhalela phakathi kwemithi, abadokotela bakhona babinikeza ukubhala kwe-muscle kusukela emhlabathini. Lezi zikhombiso zokubhala ziyabonisa ngokusheshwe ukuthi isikhombisa sisebenza kuphi, ngakho-ke kufanele kwenziwe izilungiselelo ngokuphinda-phinda kabusha ngaphambi kokufika emaqhinga amancane okuphila. Izikhombisa ezintsha zinezinsimbi eziningi ezivumela ukuthi ikhurenti elekthrikal iye kusendaweni yekhophi kuphela. Lokhu kuvumela ukuthi kuphinde kuphinde kusebenze kuphela izifibhile zokuhamba kwe-motor ozoyifuna. Isiphumo? Izindlela zokusebenza zingasafeli kakhulu ngoba akunakho ukuthi kubhekelwe inkululeko eningi kakhulu manje, izifundo zibonisa ukuthi kukhona ukuphula kwe-28%, futhi kunezindawo eziningi phakathi kwe-sikhombisa ne-nerves nakuba sibhalela emaqhinga amaningi ase-deep plexus.

Ukuthembeka kwe-Engineering: Izinketho Zokudesigna Ezimelana Ngokupheleleyo Nokublocka Kwemiphakathi Yezinsizakalo

Isikhumba esisilawunywe nesikhumba sokufakwa kwendawo esihlanganisa ukungafani kwezindlela zokugcina nokwakha kwezinsizakalo ngokupheleleyo

Isikhumba esisilawunywe ngokupheleleyo sezincamtho sibeka konke ukugcina kwemithambo kwindawo eyodwa ephakathi kwezinsizakalo, apho kuphela ama-1 ku-2 mm ayatholakala. Uma akusilawunywe, ukugcina kusho kuthola emasiko amaningi, okuyinto efuna ukuthola izimpawu ezifanele ngokukhona (false positive signals) uma ukugcina kusho kude kuma-0.5 mA. Uma sibeka ukuthola kwindawo engeyodwa yomkhombo, izincamtho ziyabiza ngokupheleleyo izimpawu zemithambo kumakhaya okupheleleyo ama-0.3 ku-0.5 mA. Lokhu kubiza ukuthi izincamtho zibe endaweni eyodwa noma cha, akukho ukuzipheka. Abadokotela bafindile ukuthi lokhu kukhetha ukuthola kwezinsizakalo nokuthola kwezinsizakalo ngokupheleleyo ngokuphakeme kwe-30 percent ngaphezu kwezincamtho ezingasilawunywe.

Ukuhlelwa kwe-Gauge (22G) nokuphakamisa kwendawo (100 mm) ukusobala kwezinkinga zokufinyela kwe-tissue nokuthi yiziphi izindawo ezithile—ukuchaza izinkinga zokufinyela kwe-lumbar noma kwe-axillary plexus

Umbane wokuphakama kwe-22 wezihlalo zikhoza ukuthi kubhekise kuzo konke izifundo zokuvavanya ukuthi ngumkhakha omuhle kakhulu wokuphakama. Kuyasebenza kakhulu ukuze kufike kuma-fascial layers amahle futhi akwazi ukuthi kushele, kodwa kusha kakhulu ukuze kucindezele isikhathi sokukhupha amaphakathi amanqamuka ngeminye yezinkulungwane eziyisine emva kokuqondwa kwamaphakathi amakhulu. Uma kuchazwa umbane wokuphakama, i-100 mm iyasebenza kahle ukuze ifike kuma-lumbar plexus amadala okunye noma kwezinye ezinomphakathi phakathi kwe-6 ne-8 centimeters kusukela esikhathini. Futhi nokuba uyasebenza kahle kuma-zinhlobo eziphakeme, le sizwe siyasebenza kahle kuma-zinhlobo eziphansi futhi, njengoko kuyasebenza kuma-axillary blocks okuphansi kakhulu kwe-3 ku-4 cm. Umbane obuthe othile ubonisa ukuthi iphakathi ayikwazi ukuthi ibukele uma iphakama kuma-tissues amahle, futhi abadokotela bangayikwenza ukuthi bafaka indlela yabo endaweni yabo, kodwa akudingi ukuthi baphule kabusha leyo yonke. Lokhu wonke ukuthi kufakwa kwezindlela zokuthi umthwalo uzofika ekupheleni kwezindawo ezingaphakade kuma-nerves, okusho ukuthi kusebenzisa umbane wokuphakama wesikhathi esingaphezu kwezinkulungwane eziyisine ngokuvamile.

Ubuqiniso bokuziphatha kwezikhathi zokuphatha: Ukupheleka kakhulu kwezindlela zokusebenza nokunciphisa ukungafanele ngephakade yekhono lokusetyenziswa kwe-Needle Yokusetyenziswa KwePlexus

Iziblocki zesibonelo sebrachial plexus: Isivinini esingama-92% ngokusebenzisa i-needle yokusetyenziswa kweplexus kunye nesivinini esingama-76% ngokusebenzisa indlela yokubona amasiko kuphela (Brull et al., 2018)

Kukusetyenziswa kwamablocki esibonelo sebrachial plexus, abadokotela besebenzisa i-needles yokusetyenziswa bafumana isivinini esingama-92% kwenkathi yabo eyokuqala, okuyisibonelo sokulinganisa nokuthi indlela yokubona amasiko kuphela iyasivinini esingama-76% njengoba kubonisiwe ngu-Brull nabanye abasebenzi bakhe ngo-2018. Ukuhlukanisa kwezingu-16 kukwenzeka ngokuthi kufunyanwa umkhondo wokugcina ngokushesha kwezimpawu zomculo, okuhlinzekile ukuthi kungenzeka ukuthi ilithium liyaphakanyiswa lapho kufanele. Abaningi abasebenzi bavuma ukuthi abaningi abazihlanganisa i-needle kungekho kahle, izindlela zizimele kancane kakhulu, kanye nezintlungo ziyathula kancane emva kokuchitha. Lezi zidingo zizinga kakhulu kubantu ababe yizinkulungwane zokuvutha noma abanemiphumela engafanele yezinhlobo zombili yezinhlobo zokubaluleka kwezindawo ezingaqondi kakhulu ngokusebenzisa izindlela zokuziphatha ezihlukene.

Imiphumela yokubhokisa ipuleksu yelumbar: Ukuphumelela kweqala kakhulu futhi ukuncamuka kwemikhahlelo yezinkampani zokubhokisa izinkampani zokubhokisa

Kulokubhokisa ipuleksu yelumbar, inzimbi yokusimula ipuleksu iyathola izinhlaka zokuphumelela ngokuphelele:

• ukuphumelela kweqala kakhulu ngo-28% kungaphansi kokubhokisa okungasimulwa
• ukuncamuka kwezinkampani zokubhokisa ngo-22% , okuphakathi kwezinkampani eziyisishiyagalombili (15 mL) kungaphansi kwezinkampani eziyisishiyagalombili nezintathu (19.3 mL)
• Ukuphakanyiswa kwezinye isithakazelo ≤4% , kungaphansi kwe-11–15% ngezindlela zokusebenza zokuzenzakalela

Lezi zimiphumela zibonisa ukuthi ukufinyelela kwezinye izindawo zokubhokisa kuyasebenza ngokuphelele (<0.5 mA), okuncamukisa isivumelwano sokubhokisa ngendlela eyodwa futhi sifanana nezinhlangano zokuhlinzekileyo zase-ASRA. Ukuncamuka kwezinkampani zokubhokisa kusuka emkhakheni kuyasiza ukuthi ukubhokisa kubhekene nesikhathi eside futhi kuncamuka isivumelwano sokubhokisa.

Ukuncamuka Kwezinkinga: Indlela Okuyisimula Inzimbi Yokupuleksu Iyabusa Isikhathi Sokusebenza Ngaphandle Kokudibanisa Isikhathi Sokusebenza

ukuphakanyiswa kwe-41% kwemiphumela yepneumothorax neziqu zezinyawo zokugcina uma kubhekwa izikhali zokusiza kwe-plexus njengesiqondiso sezinkqubo zokubheka ngokuqondisa kwe-ultrasound

Kodwa abadokotela bahlanya izikhali zokusiza kwe-plexus nesithombe sokubheka ngokuqondisa kwe-ultrasound, bafunda ukuthi kunezinkinga zepneumothorax ezingu-40% futhi kuneziqu zezinyawo zokugcina ezingaphansi, konke lokhu ngaphandle kokuthi kwenzeke ukuthi izindlela zokusebenza zizide kakhulu. Ukubheka ngokuqondisa kwe-ultrasound kubeka abadokotela bakhululekile ukubona ngokushesha ukuthi kusebenza kanjani emhlabeni, futhi uma kubhekwa ngokuhambisana nokubona ukuthi umuntu uyaphendula ngokwemoto, kusiza ukuthi kubonakale ukuthi baphikisana kanjani nezinervo. Abasayensi bafika kwezinhlobo zokugcina eziphakeme kakhulu phakathi kwe-0.3 ne-0.5 mA ngokushesha ngoba banezithombe zokubheka ngokuqondisa kanye nezimpendulo zokusebenza kwezinhlobo zokugcina zokusebenza. Ngokulingana nesindlela yezindawo zokubheka esidwala, lokhu kubili kufundisa ukuthi kunezinkinga ezinjele kwezinye. Lokhu kusiza ukuthi lezi ziqu zezinervo zibe nzima kakhulu kubantu abasebenzisa kabo kodwa futhi zibe nzima kakhulu kubantu abasebenzisa kabo kanye nabanye abasayensi.

Imibuzo Evame Ukubuzwa

Ukuthi kuyiphi ukuthwasa okuhle kwe-motor response ngokufakwa kwe-needle yase-plexus?

Ukuthwasa okuhle kwe-motor response kumhla phakathi kwe-0.3 ne-0.5 milliamps, kusiza ukuthi sibone isikhungo sesinye ngokuphelele futhi sibophelele emisweni yezinkinga.

Kungani izihlangothi zesinye zingaba zimbi kakhulu emisebenzini yokubiza isinye?

Izihlangothi zesinye zinikeza umbuzo wokusho ngokusho kokugcina kwemithambo, kusiza ukuthi sifunde ngokuphelele ngokuphakama kwe-needle futhi sibophelele emisweni yezinkinga.

Ziziphi iziphumo zokusebenzisa izikhali eziyisilansi?

Izikhali eziyisilansi ziyabeka umoya ngokuphelele ekupheleni kwazo, kusiza ukuthi sibone isikhungo sesinye ngokuphelele futhi sibophelele emisweni yezinkinga yokuqondana.

Ukuthi ukuguquka kwe-gauge nendawo yokuphakama kuyakwenza kanjani ukuthi i-needle ibe yinhloko?

Ukuthi i-22 gauge nendawo yokuqonda yami-100 mm iyabala ukuthi ibe yinhloko futhi iyabala ukuthi ibe yinhloko yokuqonda, kusiza ukuthi sibone isikhungo sesinye esikwi-lumbar nase-axillary.

Ziziphi izinguquko ezinikezwa ngokufakwa kwe-needle yase-plexus ukuthi isikhungo sesinye sibe yinhloko?

Kufisa amathuluzi okukhula kokuqala, kunciphisa izinkinga zokusebenzisa isilawuli sokugcina esikhathini esincane, nokuphepha amaphroblemi eminye imithombo yezimpilo yasebrachial neyase-lumbar plexus blocks.