Hais Txog Qhov Chaw Nyob Hauv Zos Tshuaj Txhaum

Cov tshuaj loog hauv zos muaj xws li tshuaj loog tshuaj loog, tshuaj loog hauv zos infiltration, lub cheeb tsam thaiv, thiab cov paj hlwb. Cov tom kawg tuaj yeem muab faib ua cov hlab ntsha pob tw, epidural thaiv thiab txha nraub qaum. Intravenous local anesthesia yog lwm hom tshuaj loog hauv zos 1.

1. Tshuaj loog

(1) Txhais lub xeev tsis mob uas tsim los ntawm kev tiv tauj cov tshuaj loog hauv zos nrog cov nyhuv osmotic muaj zog nrog cov mucosa hauv zos los thaiv cov hlab ntsha sab nraud los ntawm cov mucosa, uas yog hu ua tshuaj loog. Cov tshuaj loog hauv zos siv rau cov tshuaj loog yog qhov nyuaj kom ncav cuag qhov mob receptors nyob rau hauv lub epithelium, thiab tsuas tuaj yeem txo qhov tsis xis nyob los ntawm mucosa. Nws tuaj yeem siv rau qhov chaw tshuaj loog ntawm pob kws, qhov ntswg kab noj hniav, caj pas, trachea thiab bronchi.

(2) Precautions ① Before applying the cotton pad impregnated with local anesthetic on the mucosal surface, squeeze out the excess liquid medicine to prevent the toxic reaction from being absorbed too much. Padding should be performed under a headlamp or laryngoscope to facilitate proper placement 2. ②The rate of absorption of local anesthetics by the mucosa of different parts is different. Generally speaking, the application of high concentrations and large doses of local anesthetics on large mucosal areas is prone to toxic reactions, and severe cases can be fatal. The absorption rate of local anesthetics from the mucosa is equal to that of intravenous injection, especially in the tracheal and bronchial spray method. The local anesthetics are absorbed the fastest, so the dose should be strictly controlled. Resuscitation kits and medicines. ③ Before topical anesthesia, atropine must be injected to dry the mucous membranes and avoid saliva or secretions that hinder the contact between local anesthetics and mucous membranes. ④The local anesthetic ointment applied to the outer wall of the tracheal tube is preferably water-soluble. It should be noted that the onset time of anesthesia should be at least 1 minute. Therefore, it cannot be expected that the tracheal tube can be prevented from choking once it is inserted. Spray topical anesthesia of the mucous membranes of the pharynx, larynx and trachea.

2. Local infiltration anesthesia

(1) Txhais cov txheej txheej ntawm cov tshuaj loog hauv zos raws txoj kab phais phais kom thaiv cov hlab ntsha hauv cov ntaub so ntswg, uas yog hu ua local infiltration anesthesia. Siv cov koob txhaj tshuaj intradermal, lub bevel ntawm rab koob yog ze rau ntawm daim tawv nqaij, thiab tom qab nkag mus rau ntawm daim tawv nqaij, txhaj tshuaj loog hauv zos ua kua txiv kab ntxwv dawb -zoo li daim tawv nqaij mound, thiab tom qab ntawd tho los ntawm daim tawv nqaij mound. thiab txhaj tshuaj nyob rau hauv txheej. Lub koob txhaj tshuaj yuav tsum tau muab tso rau ntawm qhov chaw uas tau nkag mus rau lub sijhawm kawg kom txo tau qhov mob. Kev txhaj tshuaj ntawm cov kua tshuaj loog hauv zos yuav tsum tau ua kom lub zog ua kom muaj zog hauv cov ntaub so ntswg thiab ua kom muaj kev sib cuag nrog cov paj hlwb kom txhim kho cov nyhuv tshuaj loog.

(2) Precautions ① The injection of local anesthetic should penetrate deep into the underlying tissue and infiltrate layer by layer. The nerve endings are most distributed in the membranous surface, subsarcolemma, and periosteum, and thick nerves often pass through. The amount of local anesthetic solution should be increased. The concentration can be increased if necessary. There are few nociceptive nerve endings in muscle fibers, and only a small amount of local anesthetic can produce a certain muscle relaxation effect. ② The puncture needle should be inserted slowly. When changing the direction of the puncture needle, the needle should be withdrawn to the subcutaneous surface first to avoid bending or breaking of the needle shaft. ③Aspirate before each injection to prevent the local anesthetic liquid from being injected into the blood vessel. After the injection of the local anesthetic liquid, it is necessary to wait for 4 to 5 minutes so that the effect of the local anesthetic is perfect. ④ Do not exceed the maximum amount of each injection to prevent local anesthetic toxicity. ⑤ It is not advisable to use local infiltration anesthesia for the site of infection and cancer.

3. Lub cheeb tsam thaiv

Nyob ib ncig ntawm thaj chaw phais, tshuaj loog hauv zos yog txhaj ib ncig thiab hauv qab kom thaiv cov hlab ntsha thiab cov hlab ntsha xaus nkag mus rau hauv qhov chaw phais. Qhov no yog hu ua regional block anesthesia. Kev txhaj tshuaj ib puag ncig tuaj yeem ua tau los ntawm ib puag ncig cov ntaub so ntswg resected, lossis ncig nws lub hauv paus. Cov ntsiab lus kev khiav hauj lwm ntawm lub regional block yog tib yam li cov txheej txheem infiltration hauv zos. Lub ntsiab kom zoo dua yog tias nws tsis txhob punncturing ntawm cov ntaub so ntswg pathological, nws yog haum rau cov neeg mob sab nraud me me phais, thiab nws kuj yog haum rau cov neeg tsis muaj zog los yog cov neeg laus cov neeg mob uas lub cev tsis zoo.

4. Tso tshuaj loog hauv zos

(1) Txhais cov tourniquet rau ntawm qhov kawg ntawm ceg ntoo, thiab txhaj tshuaj loog hauv cheeb tsam sab hauv los ntawm kev sib tw kawg los thaiv cov ceg ntoo hauv qab ntawm tourniquet. Txoj kev siv tshuaj loog hu ua intravenous local anesthesia. Nws yog qhov tsim nyog rau kev phais mob caj dab distal qhov twg lub tourniquet tuaj yeem muab tso rau hauv kev nyab xeeb. Vim qhov kev txwv ntawm kev sib tw, lub sijhawm ua haujlwm feem ntau yog nyob rau hauv 1 mus rau 2 teev. Txoj kev no yuav tsum tsis txhob siv yog tias ua ke nrog cov kab mob hnyav ischemic vascular. Qhov qis kawg nkaus yog siv rau kev phais ko taw thiab calf. Ib tug calf tourniquet yog siv, uas yuav tsum tau muab tso rau hauv qab ntawm lub caj dab fibular kom tsis txhob compressing lub peroneal paj hlwb.

(2) Precautions The main complication of intravenous local anesthesia is the toxic reaction caused by a large amount of local anesthetics entering the systemic circulation after loosening the tourniquet or air leakage. Therefore, attention should be paid to: ① Carefully check the tourniquet and inflatable device before operation, and calibrate the pressure gauge; ② When inflating, the pressure should reach at least 100mmHg of the systolic pressure on the side, and monitor the pressure gauge closely; ③ Do not relax within 20 minutes after injection Tourniquet, it is best to take intermittent deflation method when placing tourniquet, and observe the patient's state of mind.

5. Nerve thiab plexus thaiv

(1) Cervical plexus block Superficial cervical plexus block tuaj yeem siv rau kev phais mob caj dab supraclavicular, thaum lub caj dab sib sib zog nqus, xws li kev phais thyroid, carotid endarterectomy, thiab lwm yam, tseem yuav tsum tau sib sib zog nqus cervical plexus thaiv. Txawm li cas los xij, vim hais tias lub caj dab tseem innervated los ntawm plaub khub ntawm cranial hlab ntsha kawg, cov nyhuv ntawm lub ncauj tsev menyuam plexus thaiv ib leeg tsis zoo tag nrho, thiab cov tshuaj adjuvant tuaj yeem siv los txo qhov mob.

(2) Brachial plexus block muaj xws li transcervical brachial plexus block, intermuscular groove block, supraclavicular brachial plexus block, subclavian brachial plexus block, thiab axillary brachial plexus block. txoj kev mus kom ze. Cov nyhuv thaiv ntawm tsib lub brachial plexus mus kom ze sib txawv vim lub cev nqaij daim tawv ntawm txhua qhov, thiab qhov innervation ntawm txhua qhov ntawm sab sauv sab sauv kuj txawv. Yog li ntawd, qhov tsim nyog tshaj plaws blockade mus kom ze yuav tsum tau xaiv raws li innervation ntawm qhov chaw phais.

(3) Upper extremity nerve block Upper extremity nerve block feem ntau yog tsim rau forearm lossis tes phais, thiab tseem tuaj yeem siv los ua kev kho mob tsis tiav brachial plexus block. Feem ntau suav nrog cov paj hlwb nruab nrab, ulnar hlab ntsha thaiv thiab radial paj hlwb, uas tuaj yeem thaiv ntawm lub luj tshib lossis dab teg. Yog tias kev phais ntiv tes ua tiav, cov hlab ntsha interdigital tseem ua tau.

(4) Cov hlab ntsha qis qis tag nrho cov qis qis qis qis yuav tsum tau thaiv lub lumbar plexus thiab sacral plexus tib lub sijhawm. Vim tias qhov xav tau ntau yam kev txhaj tshuaj thiab kev ua haujlwm tsis yooj yim, nws tsis tau siv dav hauv kev kho mob. Txawm li cas los xij, lumbosacral plexus block tuaj yeem siv tau thaum lub xaib xav tau tshuaj loog raug txwv lossis thaum cov tshuaj loog neuraxial yog contraindicated. Tsis tas li ntawd, lumbosacral plexus block kuj tseem siv tau los ua ib qho ntxiv rau kev siv tshuaj loog rau kev ua haujlwm tom qab analgesia.

Although lumbar plexus block combined with intercostal nerve block can be used for lower abdominal surgery, it is rarely used clinically. Combined iliohypogastric nerve and ilioinguinal nerve block is a simple and practical method of anesthesia, which can be used for surgery in the area innervated by the iliohypogastric nerve and the ilioinguinal nerve. Hip surgery requires blocking of all lumbar nerves except the iliohypogastric and ilioinguinal nerves. The easiest way to do this is to block the lumbar plexus (lumbar plexus block in the psoas space). Thigh surgery requires anesthesia of the lateral femoral cutaneous nerve, femoral nerve, obturator nerve and sciatic nerve, and a lumbar plexus block in the psoas major space combined with sciatic nerve block can be performed. The lateral femoral cutaneous nerve and the femoral nerve can be combined or blocked separately for the anterior thigh surgery, and the "three-in-one" method can also be used. The lateral femoral cutaneous nerve block alone can be used for skin graft anesthesia, and the simple femoral nerve block is suitable for Postoperative pain relief for femoral shaft fractures, quadriceps plasty or ilium fracture repair. A combined lateral femoral cutaneous and femoral nerve block combined with a sciatic nerve block usually prevents tourniquet pain because the obturator nerve innervates very little skin. Open knee surgery requires block of the lateral femoral cutaneous nerve, femoral nerve, obturator nerve, and sciatic nerve. Combined femoral nerve and sciatic nerve block can also meet the surgical requirements. Distal knee surgery requires blocking of the saphenous nerve branches of the sciatic and femoral nerves, and ankle blocks can be used for foot surgery.

Yog tias koj muaj lus nug, thov hu rau peb. Peb lub tuam txhab tuaj yeem tsim ntau yam koob txhaj tshuaj, koob tshuaj kho mob, koob txhaj tshuaj, koob tshuaj hypodermic, koob txhaj tshuaj, koob tshuaj tiv thaiv kab mob, koob txhaj tshuaj, koob txhaj tshuaj, koob tshuaj tua tsiaj, koob xaum koob, koob ovum khaws koob, koob txhaj tshuaj, thiab lwm yam Yog tias koj xav tau kev kho. koob cov khoom, thov hu rau peb. Peb tos ntsoov rau koj qhov kev nug! Qhov zoo ntawm cov khoom tsim nyob rau hauv peb lub Hoobkas yuav txaus siab rau koj!

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