Daim ntawv thov ntawm Echogenic koob nyob rau hauv Emergency Trauma Analgesia Thiab Nerve Block

https://www.nature.com/articles/s41598-024-72620-8

1. Cov Ntsiab Lus Kho Mob

Cov neeg mob thaum muaj xwm txheej ceev xws li pob txha pob txha, cov nqaij mos avulsion thiab kev sib koom ua ke feem ntau raug kev txom nyem los ntawm qhov mob hnyav, yuav tsum tau ceev thiab ua tau zoo ntawm cov hlab ntsha thaiv analgesia. Txawm li cas los xij, cov xwm txheej xwm txheej ceev tau muaj cov kev txwv tseem ceeb: cov neeg mob muaj cov cim tseem ceeb tsis ruaj khov, pom tseeb ntawm ceg o thiab cov ntaub so ntswg hloov chaw tom qab raug mob, ua rau pom qhov muag plooj ultrasound ntawm cov hlab ntsha thiab kev txheeb xyuas nyuaj ntawm cov qauv anatomical. Cov koob tshuaj zoo tib yam muaj kev pom tsis zoo, thiab qhov muag tsis pom kev yog qhov ua rau muaj kev raug mob thib ob rau cov ntaub so ntswg thiab cov hlab ntsha. Tsis tas li ntawd, kev ua haujlwm xwm txheej ceev yuav tsum tau siv tshuaj loog sai thiab ua tau zoo, thaum ib txwm siv cov kev taw qhia ib txwm muaj qhov chaw qeeb qeeb, qis ib qho - lub sijhawm ua tiav, thiab tsis tuaj yeem ua tau raws li qhov xav tau ntawm kev mob analgesia sai sai. Tsis tas li ntawd, kev vam khom ntau dhau ntawm opioid analgesics hauv kev kho mob xwm txheej ceev yog ib qho yooj yim ua rau muaj kev cuam tshuam tsis zoo xws li ua pa nyuaj siab thiab kiv taub hau, nrog kev nyab xeeb thiab tsis zoo rau tus neeg mob.

2. Txoj Cai Ua Haujlwm ntawmEchogenic Nerve Block Needles

Echogenic paj hlwb thaiv cov koob tau hloov kho tau zoo rau cov xwm txheej kub ntxhov nrog rau lawv qhov zoo dual -txoj haujlwm tseem ceeb. Lub siab -precision laser echo marking thev naus laus zis ua rau lub cev rab koob tuaj yeem muaj qhov ruaj khov siab- pom kev ci ntsa iab hauv cov ntaub so ntswg o thiab cuam tshuam, tiv thaiv cov duab cuam tshuam los ntawm cov ntaub so ntswg edema thiab ntshav stasis, thiab paub qhov tseeb - lub sij hawm kom meej meej ntawm koob trajectory. Lub tshuab hluav taws xob stimulation system tuaj yeem ntes cov cim bioelectrical ntawm lub hom phiaj paj hlwb. Txawm hais tias tus qauv anatomical distorted tom qab raug mob, nws tuaj yeem txiav txim siab qhov chaw txheeb ze ntawm rab koob thiab cov hlab ntsha los ntawm cov hlab ntsha reflex thiab cov leeg nqaij contraction, tsis txhob muab qhov yuam kev los ntawm kev hloov pauv ntawm cov qauv. Kev txheeb xyuas dual lub zeem muag thiab cov teeb liab hluav taws xob zoo txhim kho kev tiv thaiv - cuam tshuam muaj peev xwm ntawm kev ua haujlwm puncture, paub qhov chaw nrawm thiab raug nyob rau hauv cov ntaub so ntswg thaum muaj xwm txheej ceev, thiab ua tiav cov paj hlwb zoo hauv lub sijhawm luv luv.

3. Kev faib cov cuab yeej thiab kev hloov kho cov xwm txheej

Raws li hom kev raug mob xwm txheej ceev thiab kev ua haujlwm raws sijhawm, cov koob echogenic tau muab faib ua hom kev kub ntxhov ceev ceev thiab tiv thaiv - edema txhim kho hom. Cov koob txhaj tshuaj ceev ceev echogenic (20G-24G) yog tsim rau niaj hnub thaum muaj xwm txheej ceev limb fracture dislocation analgesia, nrog rau qhov nrawm nrawm thiab ruaj khov kev ua haujlwm ntawm lub suab nrov, ua tau raws li kev kho mob sai ntawm cov neeg mob mob me thiab nruab nrab. Cov tshuaj tiv thaiv -edema txhim kho echogenic koob (18G-22G) tau txais cov qauv zoo tshaj plaws ntawm lub suab nrov, uas tuaj yeem tswj xyuas cov txiaj ntsig zoo hauv edema thiab hematic stasis cov ntaub so ntswg, thiab tshwj xeeb tshaj yog siv rau kev raug mob hnyav nrog qhov pom tseeb ntawm ceg o thiab anatomical distortion. Tag nrho cov koob tshwj xeeb thaum muaj xwm txheej ceev tau txais kev ntim khoom tsis muaj menyuam, txhawb kev qhib thiab siv tau sai, hloov mus rau kev ua haujlwm tau zoo thiab ceev ceev ntawm lub chaw haujlwm xwm txheej ceev.

4. Cov Txheej Txheem Kev Ua Haujlwm

Rau cov neeg mob raug mob thaum muaj xwm txheej ceev, ua ntej ua tiav qhov tseem ceeb ntawm kev saib xyuas thiab kev kho mob ua ntej hemostasis, txiav txim siab sai sai rau qhov chaw raug mob thiab cov hlab ntsha thaiv ntau yam, thiab xaiv qhov sib tw echogenic koob specification. Ceev ceev debug lub cuab yeej ultrasound, kho qhov kev sojntsuam zaus raws li cov ntaub so ntswg o degree, thiab ceev nrooj nrhiav cov kev khiav haujlwm ntawm lub hom phiaj paj hlwb. Txais yuav sai sai hauv - cov txheej txheem dav hlau puncture, ua ntej lub koob sai thiab ruaj khov, saib xyuas cov koob nkag hauv lub sijhawm ntawm ultrasound, thiab pib lub paj hlwb rau kev kuaj xyuas. Tom qab paub meej tias lub koob taub yog nyob ze rau lub hom phiaj paj hlwb thiab tsis muaj qhov txawv txav ntawm lub vascular puncture, txhaj tshuaj tsawg - koob tshuaj loog hauv zos sai thiab sib npaug. Tiag -lub sij hawm soj ntsuam cov tshuaj diffusion thiab cov paj hlwb, ua kom tiav cov tshuaj analgesia sai, thiab zam lub sijhawm ua haujlwm ntau dhau los cuam tshuam rau kev kho mob tom qab.

5. Kev Paub Txog Kev Kho Mob

Hauv kev kho mob thaum muaj xwm txheej ceev, echogenic paj hlwb thaiv koob tau txhim kho kev ua tau zoo thiab kev nyab xeeb ntawm kev ua xua thaum muaj xwm txheej ceev. Piv nrog rau cov cuab yeej siv niaj hnub, lub sij hawm tso tawm ntawm cov hlab ntsha yog luv luv los ntawm ntau dua 40%, thiab ib qho - lub sij hawm puncture zoo npaum li cas yog nce los ntawm 70% mus rau 95%, uas ua tau zoo kom tsis txhob raug mob thib ob los ntawm kev sib tsoo rau cov neeg mob raug mob. Lub dual -mode positioning thev naus laus zis tuaj yeem ua tiav cov hlab ntsha hauv qab lub cev o thiab anatomical distortion, daws qhov teeb meem nyuaj ntawm qhov chaw nyuaj ntawm cov hlab ntsha tawg. Cov kws kho mob cov txheeb cais qhia tau hais tias daim ntawv thov ntawm echogenic koob paj paj thaiv txo qis kev siv opioid analgesics hauv cov neeg mob thaum muaj xwm txheej ceev los ntawm 60%, txo qhov tshwm sim ntawm kev nyuaj siab ua pa, xeev siab thiab lwm yam kev phiv tshwm sim. Lub caij no, cov nyhuv analgesia sai stabilizes tus neeg mob cov cim tseem ceeb thiab tsim cov xwm txheej zoo rau kev phais tom ntej thiab txo cov pob txha.

6. Cov ntsiab lus thiab sublimation

Kev raug mob thaum muaj xwm ceev analgesia muaj cov kev cai tseem ceeb ntawm kev nrawm, raug thiab kev nyab xeeb, thiab qhov chaw kho mob nyuaj thiab hloov pauv tau ib txwm txwv cov txiaj ntsig ntawm cov paj hlwb ib txwm siv. Qhov pom kev tsis zoo thiab tsis tshua muaj kev tiv thaiv - cuam tshuam peev xwm ntawm cov cuab yeej tsoo tsoos ua rau muaj kev ua haujlwm tsawg thiab muaj kev pheej hmoo siab ntawm kev ua xua thaum muaj xwm txheej ceev. Echogenic paj block koob hloov mus rau qhov nyuaj ib puag ncig ntawm cov ntaub so ntswg los ntawm optimized ncha txhim kho cov qauv thiab dual ntse positioning technology, paub sai thiab meej paj block analgesia, txo cov dependence ntawm opioid tshuaj, thiab txo cov kev pheej hmoo ntawm kev phiv tshuaj. Nws muab txoj kev nyab xeeb thiab ua tau zoo tshiab analgesia rau kev kho mob thaum muaj xwm txheej ceev, thiab txhim kho kev kho mob xwm txheej ceev tag nrho.

7. Cov kev cia siab rau yav tom ntej thiab cov lus qhia

Kev kho mob thaum muaj xwm txheej ceev tab tom txhim kho mus rau qhov tseeb thiab kev cuam tshuam tsawg kawg nkaus, thiab qhov nrov ntawm kev ua haujlwm siab -cov paj hlwb thaiv kev siv tshuaj tua kab mob yog ib qho kev inevitable. Nws tau pom zoo tias cov chaw haujlwm xwm txheej ceev tau txhawb nqa daim ntawv thov ntawm echogenic paj hlwb thaiv koob, tsim cov txheej txheem kev ua haujlwm ceev ceev haum rau ntau hom kev raug mob, thiab txhim kho cov txheej txheem kev ua haujlwm ntawm cov kws kho mob xwm txheej ceev. Cov khoom lag luam tuaj yeem tsim kho cov koob tshwj xeeb echogenic thaum muaj xwm txheej ceev, txhim kho qhov kev ua haujlwm nrawm nrawm thiab tiv thaiv - edema imaging peev xwm. Nyob rau tib lub sijhawm, ua tiav ntau-cov kev tshawb fawb hauv chaw kho mob los sau cov txheej txheem kho mob kom zoo rau kev mob xwm txheej kub ntxhov sib txawv, thiab nthuav dav daim ntawv thov nyob rau hauv ua ntej- tsev kho mob thaum muaj xwm ceev analgesia thiab cov xwm txheej cawm neeg coob.