Puas yog Nws Ib txwm Tsis Muaj Kev Ruaj Ntseg Ntawm Qis Qis Tom Qab Nerve Block Puncture Koob?

Thaiv ntawm paj hlwb

Cov tshuaj loog hauv zos yog txhaj ib ncig ntawm lub paj hlwb, plexus thiab ganglia los thaiv nws cov impulse conduction thiab ua rau thaj chaw innervated tsim tshuaj loog, uas yog hu ua paj hlwb. Lub paj hlwb raug txhaj rau hauv ib qho chaw nkaus xwb kom tau txais thaj tsam loj ntawm tshuaj loog. Txawm li cas los xij, nws yuav ua rau muaj teeb meem loj, yog li kev ua haujlwm yuav tsum paub txog lub cev nqaij daim tawv hauv zos, nkag siab txog cov ntaub so ntswg uas rab koob yuav dhau mus, nrog rau cov hlab ntsha nyob ze, lub cev thiab lub cev kab noj hniav. Cov paj hlwb feem ntau pab tau rau kev sib cuam tshuam, suborbital, sciatic, ntiv tes (ntiv taw) cov hlab ntsha qia blocks, ncauj tsev menyuam plexus thiab brachial plexus blocks, nrog rau stellate ganglion thiab lumbar sympathetic ganglion blocks rau kev kuaj mob thiab kho.

Tus neeg mob pw tsaug zog, shaved lub caj npab cov plaub hau, abducted tus cuam tshuam limb 90 degree, thiab ces flexed caj npab nce 90 degree, nyob rau hauv ib tug tub rog salute txoj hauj lwm. Sawv ntsug ntawm qhov cuam tshuam, tus anaesthete tau hnov ​​​​txog axillary artery pulsation ntawm kev sib tshuam ntawm cov npoo qis ntawm pectoralis loj thiab cov npoo nruab nrab ntawm caj npab, thiab hnov ​​​​qhov siab tshaj plaws pulsation mus rau sab saum toj ntawm axilla (Daim duab. {{2} }). Thaum lub sijhawm ua haujlwm, rab koob tau tuav ntawm sab tes xis, qhov taw qhia thiab ntiv tes nruab nrab ntawm sab laug tes tau tsau rau ntawm daim tawv nqaij thiab cov hlab ntsha, thiab cov hlab ntsha tau pierced perpendicular rau ntawm daim tawv nqaij ntawm flex lossis ulnar ntug ntawm cov hlab ntsha. Thaum lub sheath yog punctured, lub breakthrough yog pom tseeb, uas yog, qhov kev vam meej nres. Thaum tus ntiv tes tso tawm, rab koob ntaus nrog lub mem tes ntawm cov hlab ntsha, qhia tias qhov kawg ntawm rab koob yog nyob rau hauv lub axillary sheath. Tom qab tsis muaj ntshav tau muab rho tawm, 25 ~ 30ml ntawm cov tshuaj loog hauv zos tau txhaj. Nias qhov kawg ntawm qhov chaw txhaj tshuaj thaum txhaj tshuaj yog qhov tsim nyog rau qhov sib txawv ntawm cov kua mus rau qhov sib thooj thiab qhov kawg ntawm tus pin axillary, txhawm rau thaiv cov hlab ntsha myocutaneous. Vim hais tias cov hlab ntsha musculocutaneous tau tawm ntawm axillary sheath nyob rau theem ntawm cov hlaws txheej txheem thiab nkag mus rau hauv cov leeg coracobrachial, nws feem ntau tsis yooj yim los thaiv tag nrho, thiab lub puab tsaig thiab lub hauv paus ntawm tus ntiv tes xoo hauv qab nws tswj kom muaj cov tshuaj loog tsis zoo. .

Kev taw qhia thiab cov teeb meem: Brachial plexus block yog tsim rau kev phais sab sauv sab sauv, txoj kev intermuscular sulcus yog tsim rau kev phais lub xub pwg, thiab txoj kev axillary yog tsim nyog rau kev phais forearm thiab tes. Tab sis peb txoj kev no txhua tus muaj peev xwm ua kom muaj tshuaj loog hauv zos.

Phrenic paj hlwb palsy, recurrent laryngeal paj hlwb palsy thiab Homer syndrom kuj induced los ntawm intermuscular sulcus txoj kev thiab supracclavian txoj kev. Horner syndrome yog tshwm sim los ntawm stellate ganglion block, ipsilateral cov menyuam kawm ntawv constriction, qhov muag ptosis, qhov ntswg mucous membrane congestion, lub ntsej muag flushing thiab lwm yam tsos mob.

Yog tias qhov puncture tsis tsim nyog, txoj hauv kev supraclavicular tuaj yeem ua rau pneumothorax, txoj hauv kev intermuscular sulcus tuaj yeem ua rau siab epidural block, lossis txhaj tshuaj kua dej rau hauv qhov chaw subarachnoid yuav ua rau txhav txhav.