中英双语：超声波引导下锁骨下臂丛神经阻滞Duke

een the artery and vein.

装置内对准胸骨骨朝向，正好在胫骨的尾端和喙突的前端。这两个构造在这之中用绿色标出。你可以想得到如下图表：在这之中我们看着腹部大肌和腹部小肌，一个大是常为脊柱和肾脏。脊柱将是我们的主要简而言之。围绕着脊柱的是三束，之后侧束和后束有时候在两头侧，而前端束则夹在脊柱和肾脏二者之间。

The goal of the block is to advance the needle from the cephalot aspect through the pec muscles and land the needle tip just deep to the artery at the 6 o'clock position.

大脑受阻的目的是将叉从两头侧通向腹部肌，并使叉尖在 6 点钟右方有旧入脊柱。

Things are clustered tightly here, and you’ll want to make good use of hydrodissection to keep those cords clear of the needle path. And it's often the case that you can see your artery well, but don't he a clear image of any of the cords. The great thing about this block is it doesn't matter if you put your local at 6 o'clock, you'll be in great shape. We’ll typically use between 20 and 30 ml of local depending on the patient's size and the pattern of spread.

这之中的构造聚集得很彼此之间，你需要就让来进行出水转化来使三束避开受阻叉。有时候完全，你可以更好地看着脊柱，但不可认清三束的直观图表。这种受阻法则的益处是，如果你把叉两头摆置于置于6点钟朝向也没有联系，你时会想得到更好的图表。我们有时候时会应用于20至30毫升的务药出水，这取决于病患的体型和蔓延方式也。

Here's an example of why it's not crucial to see the cords. I can maybe see the lateral cord in this image, but I wouldn't bet my life on it. That's okay, because my goal is to hit that 6 o'clock spot. You can see the local lifting the artery up and spreading in a u-shaped pattern. This is what you want to see.

这之中有一个例证，说明为什么看着三束极为最主要。在这张图片之中，我也许能看着之后侧束，但我不可保证。这没联系，因为我的目标是6点钟的右方。你可以看着务药出水把脊柱抬起来，并以U凸模式进行时。这就是你想要看着的。

Okay, so here we see the axillary artery underneath the pec minor muscle, we can appreciate what looks like the lateral cord on the cephalad. The needle passes through the pec major and pec minor muscles, annd hydrodissection lifts the pec fascia of the artery. We want to scrape the paint off the artery passing very close to it tangentially, while we continue to hydro dissect. There the needle tip is deep to the artery, and we get immediate flow after passing through that fascial layer. Our aim is to see local anesthetic directly underneath the artery with no intervening structures or layers.

好的，所以在这之中我们看着了腹部小肌一个大的常为脊柱，我们可以看着两头侧看上去像之后侧束的进去。叉两头通向腹部大肌和腹部小肌，出水转化提升了脊柱的腹部肌肾脏。我们像刮掉脊柱的涂一样从单位向量朝向北边脊柱，同时暂时进行时出水转化。叉尖有旧入到脊柱下方，在通过该肾脏层后，我们几天后切除务药出水。我们的目的是在脊柱的正下方看着务部注射药，并且没有任何构造或肾脏其本质的干扰。

Like the supraclicular, this is a spinal of the arm, meaning you block nearly the entire upper limb with one ceat. At this location, you don't reliably get the suprascapular nerve, which branches off the superior trunk. And for that reason, the interclicular approach is not ideal for shoulder surgery. Everything else is fair game, though arm, elbow, forearm, and hand.

与胫骨上臂丛大脑受阻一样，这也是双双手的“腰麻”，意味着你几乎阻断了整个下肢。但却是需要留意的是，在这个右方，你不可可靠地获得胸骨上大脑受阻，该大脑是下肢主干的支系。由于这个或许，胫骨下入南路不是肩部移植双手术的理想选择。其他口腔都是一样的，仅限于整个双双手、肩部、双脚和双手。

The infraclicular approach is a forite of many. For one principal reason, It's a single injection one and done. If you put 30 ml of local anesthetic immediately deep to the artery, you he a 100.0 percent success rate, or at least very close. This is because you only he three chords, and they all lie in the same neurovascular plane as the artery.

胫骨下臂丛大脑受阻是部分人的首选。主要或许之一是它需一次切除就能完成。如果你把30毫升的务部注射药切除到脊柱有旧处，你有100.0%的存活率，或者将近极其相对于。这是因为在这之中臂丛大脑只有三束，而且三束都坐落和脊柱一样的大脑静脉膜内。

The supraclicular brachial plexus block by comparison, tends to fail occasionally with a single corner pocket injection, and it often requires two or even three separate needle passes and aliquots of local anesthetic to get a good effect. The other plus relates to catheters, because the catheter is going through two fairly thick muscles. It holds well and doesn't move compared to a supraclicular location, where the place is shallow and the patient's neck is moving constantly. The chest wall is also more comfortable place to he a catheter dressing compared to the neck.

相对来说之下，胫骨上臂丛大脑受阻，多半时会因为实体的角落袋子内切除而失败，而且通常需要两次甚至三次除此以外进叉和而时会的务部注射药才能获得很差的优点。另一个益处是与气管有关，因为气管要通向两块十分厚度的肌肉。与胫骨上右方相对来说，它始终保持得更好，而且不必方向移动，而胫骨上的右方很青绿色，病患的脖子在急剧方向移动。并且与腹部相对来说，腹部壁也是摆置于气管敷料的更为透气的；也。

Here are some inffraclicular tips.

First, there are a lot of vessels in this part of the body, so watch for where your needle trels. The two that are most at risk are the thorac acromial artery or its branches and the cephalic vein. These typically lie in the plane between the two pec muscles. So it's a good idea to check for them before planning your needle trajectory.

这之中有一些胫骨下受阻的小法则：

首先，这之中有很多静脉，所以要留意你的叉两头所经过的；也。最危险的两条是腹部肩峰脊柱及其支系和两头肾脏。这些有时候坐落两块腹部肌二者之间的矩形内。因此，在规画进叉关键点之前，不错检查它们。

Second, it's a common novice error to inadvertently let the probe slide medial or lateral making it challenging to find your landmarks. As long as you keep the narrow pec minor muscle on the screen, you should be in good shape. Here's our nice view. When the probe slides medial we lose pec minor end up very close to the chest wall. Going the other way, we pass by our optimal view, and then end up losing the artery as we begin to see more deltoid and shoulder structures. Keeping both pec muscles on the screen anchors your image in the right place.

第二，一个类似的新双手缺失就是不经意间使装置内向内或之外斜面，使其无法找到标志物。在屏幕上始终保持看着较宽的腹部小肌，你就可以想得到好图表。这是我们想得到的直观图表。当装置内向前端斜面时，腹部小肌在相对于腹部壁的朝向消失。反过来向之后侧方向移动装置内，我们经过最佳配置文件，当我们开始看着更为多的三角肌和双脚构造时，脊柱消失在屏幕之中。当同时看着腹部大肌和腹部小肌时就是你的最佳图表。

And lastly, a criticism of the infraclicular approach is that it's relatively steep and deep, which makes it difficult to see the needle at times. Heel toeing the probe, so the beam is angled more towards the head may only change the angle by 10 to 15 degrees, but this vastly improves the likelihood you'll see your needle. Alternatively, we'll pull out the curvilinear probe sometimes, especially for patients with a lot of pec muscle. The fan shaped angle of the beam can improve needle visualization, especially in hey patients.

终于，胫骨下入南路的一个意见是，它相对较陡峭和有旧，这使得有时很难看着叉两头。将装置内向双脚垂直，使声束更为多地朝向两头部，这可能时会只时会彻底改变10至15度的角度，但这最大限度地增加了你看着叉的可能时会性。另之外，我们有时也时会用曲阵装置内，特别是对腹部肌很低度发达的病患。声束的扇凸角度可以增加叉两头的可视性，特别是对于身型大的病患。

And finally, the retroclicular or RAPTIR approach can provide excellent needle visualization due to the flattened trajectory.

For an in-depth discussion of the RAPTIR(retroclicular approach to the infraclicular region), check out this video.

终于，由于关键点低平，胫骨后或RAPTIR入南路可以更好地看着受阻叉。

本文转载自其他网站，不代表人身体健康界观点和立场。如有内容和图片的版权责难，特地及时联系我们（邮箱：guikequan@hmkx.cn）

。

英太青止痛蓝白盒效果好吗
腰肌劳损腰疼怎么缓解
王婧
颈椎病头疼怎么缓解
阳了吃什么药好得快