Epidural ponksyon zegwi blòk pike metòd

1. Metòd ponksyon avèg Pike epidural ka fèt pa metòd dwat ak lateral. Pwosesis epinyè nan kòl matris, anwo thoracic ak lonbèr vètebral yo paralèl youn ak lòt, epi yo souvan defann apwòch dwat -nan. Pou granmoun aje ki gen ligaman kalsifye supraspinous ak koub epinyè restriksyon, metòd antre lateral la jeneralman apwopriye.

Metòd pénétration dirèk: Yo fè yon ti mòn po nan espas pwosesis entèspinous chwazi a toupre kwen anwo nan pwosesis la epinyè enferyè, ak Lè sa a, enfiltre kouch pa kouch. Ka po a ak ligaman dwe twou ak yon zegwi 15 G byen file, ak Lè sa a, zegwi epidural la mete nan twou zegwi a. Kote zegwi a dwe sou liy midsagittal kolòn vètebral la. Pwent zegwi a penetre po a, lar, ligaman supraspinous, ligaman interspinous, ligamentum flavum ak lòt kouch tisi. Rezistans nan penetrasyon ligamentum flavum la toudenkou disparèt, ki endike ke li te antre nan espas epidural la.

Metòd antre bò Metòd antre bò a se mete zegwi a 1.5 cm akote espas pwosesis la epinye, epi twou zegwi a nan yon ang 75 degre ak po a pèse twou pwosesis entèspinous la, evite ligaman supraspinous la ak ligaman entèspinous la, ak antre nan ligamentum flavum la. espas epidural

Metòd kanulasyon pou blòk epidural kontinyèl: Lè yo detèmine ke zegwi epidural la te antre nan espas epidural la, se bizote zegwi a dirije sou bò kranyal oswa caudal, epi yo mete yon zegwi gradye nan lumèn zegwi epidural la. 20 G katetè. Katetè a ta dwe pwolonje pi lwen pase pwent zegwi a ak nan espas epidural la pa 3 a 4 cm. Tache katetè a ak yon pansman esteril. Yo mete katetè a pou pénétrer dwòg la plizyè fwa oswa kontinyèlman.

Dwòg ak dòz: Premyèman, enjekte yon kantite tès anestezi lokal, jeneralman 3-5 ml 1.6 pousan -2 pousan lidokayin. Anvan piki, li dwe souse tounen pou konfime ke pa gen san ak likid cerebrospinal.

2. Ponksyon anba pwezante ultrason Pozisyon ultrason ak teknoloji konsèy yo te lajman itilize nan anestezi chirijikal minimòm pwogrese, blòk rejyonal ak ponksyon vaskilè, elatriye Li bay tou yon nouvo metòd pou twou epidural ak kateterizasyon. D '-wo kalite ultrason ka ede operatè a byen vit ak byen lokalize espas epidural la, gide zegwi a pike ak katetè nan espas epidural la, epi ranpli tib la pwezante epidural, ki ka diminye kantite eseye {{2} }}ons epi redwi malèz pasyan an. Amelyore satisfaksyon pasyan yo.

Etap operasyon yo se premye eskane epi make pwen ki pi wo nan krèt ilyak la, Lè sa a, deplase pwofonde a nan tèt la pou tcheke chak espas entèvèrtebral lonbèr ak pwosesis epin, epi lokalize twazyèm pwosesis spinous la nan entèseksyon an mezire. Yo te idantifye estrikti ki gen rapò epidural yo epi yo te montre espas ki pi klè, epi pwen pike a te lokalize apeprè 1.0 cm soti nan liy mitan an nan espas sa a. Sit pike a te dezenfekte regilyèman, epi apre anestezi lokal ak 1 pousan lidokayin, yo te pran pwen pike a kòm sant sond la, epi yo te fè yon eskanè seksyon longitudinal paramedian.

Ultrasound sonography (from superficial to deep) shows that the most superficial layer is the skin, the fascia is linear hyperechoic, the adjacent spinous processes are "city wall-like", the bone surface is arc-shaped linear hyperechoic, and the back is covered by acoustic shadows. At the top of the two spinous processes, due to the different orientations of the ligament fibers in each group, the ultrasound beam produces anisotropy, and the supraspinous ligament, interspinous ligament and interarch ligament are moderately low and uneven echo images. The dura mater and the ligamentum flavum have dense tissue structures, and the sonogram shows moderately hyperechoic bands, mainly the ligamentum flavum. Between the dura and the ligamentum flavum is the epidural space, and moderate to low echoes can be seen in the cavity. Epidural fat sonography (Figure 6). The operator inserts the epidural needle through the ligamentum flavum into the epidural space according to the acquired images of the intervertebral space. When the puncture needle reaches the ligamentum flavum, the resistance increases, withdraw the puncture needle core, connect the low-resistance syringe, and slowly inject the normal saline containing air bubbles; when the puncture needle breaks through the ligamentum flavum, no cerebrospinal fluid and blood are withdrawn, and the air bubbles are not compressed. The normal saline bolus injection without resistance confirms the successful puncture.

3. Ponksyon anba C-pozisyon nan bra C Anba fluoroskopi C-bra, yo ka idantifye aklè pwosesis spinous kò vètebral la epi pozisyon an tan reyèl -zegwi ponksyon an kapab klèman wè, ki ka amelyore pousantaj siksè nan twou.

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