【正文】 :969. 腋部徑路超聲圖中針頭位置 （箭頭所示） Needle position of axillary nerve block in sonogram (arrows) AA:腋動(dòng)脈 axillary artery Axillary Block Transverse sonogram in the midhumeral region showing two terminal branches of the brachial plexus as hypoechoic nodules (N with arrows). BA brachial artery。 BM biceps muscle。 H humerus。 TM triceps muscle. Musculocutaneuous Nerve Block A 12MHz ultrasound image demonstrating the musculocutaneous nerve and surrounding structures. B, bone (humerus)。 Bi, biceps muscle。 CB, coracobrachialis muscle。 A, axillary artery。 v, axillary vein. The musculocutaneous nerve is found in the juncture between the biceps and coracobrachialis muscles. The nerve, as does the median nerve, appears as a constellation of hypodense (dark) grapelike structures with hyperechoic (bright) rings. UltrasoundGuided Musculocutaneous Nerve Block ? Spence, Sites, and Beach 199 (四 )神經(jīng)刺激器定位 Location with nerve stimulator 1. 周圍神經(jīng)刺激器 Peripheral nerve stimulator 神經(jīng)刺激器的 優(yōu)點(diǎn) Advantages ? 刺激后肌肉反應(yīng)的指標(biāo)客觀明確 ? Objective and correct signs after stimulation ? 用于無(wú)法準(zhǔn)確說(shuō)明異感或定位困難病人 (小兒、老年、不合作用及神智不清的病人 ) ? Used in pediatrics, elderly, disoperative and unconscious patients ? 最大程度減少神經(jīng)損傷 ? Reduce nerve damages ? 神經(jīng)阻滯成功率較高 ? High successful rate 病人感覺(jué)觸電、痛苦 Electric shock sensory and disfort feeling 血管內(nèi)意外注藥危險(xiǎn) Danger in intravessel infusion 麻醉效果難以保證 Poor analgesia sometime 定位無(wú)客觀指標(biāo) No objective signs 成功率相對(duì)低 Comparative lower success ratio 病人感覺(jué)舒適 Feel fort 血管內(nèi)意外注藥少 Avoid intravessel infusion 麻醉鎮(zhèn)痛效果滿意 Better analgesia 定位指標(biāo)明確 Precise amp。 objective location 成功率高，并發(fā)癥少 Higher success ratio amp。 rare plication 傳統(tǒng)異感定位法 Sensory location 神經(jīng)刺激器定位 Stimulator location 神經(jīng)刺激器與傳統(tǒng)異感定位的對(duì)比 Comparison of nerve stimulator and traditional sensory location 世界上第一個(gè)神經(jīng)刺激器 First nerve stimulator in the world 1912 Stimuplex HNS神經(jīng)刺激器 Stimuplex HNS stimulator Stimuplex HNS ? 采用全數(shù)字顯示技術(shù)和人性化設(shè)計(jì) ? Digital display and personal design ? 具有兩種不同的顯示方法 (預(yù)設(shè)電流和實(shí)時(shí)顯示 ) ? Two different display (initial current and display in real time) ? 電流范圍在 01mA或 05mA，調(diào)節(jié)精度高 ? Current ranges 01 or 05mA, precise regulation ? 脈沖時(shí)間有 、 ? Impulse time with , , ? 脈沖頻率可設(shè)在 1,2Hz ? Impulse frequency 1 or 2Hz ? 具有不同報(bào)警功能 (防止電路故障和低電池量 ) ? Different alarm function (prevent electrocircuit disorder and low battery) Stimuplex Dig RC 單人操作 Operation with single doctor Stimuplex Dig RC 僅有一個(gè)調(diào)節(jié)按鈕 Only has one regulating button ? 電流的設(shè)置和測(cè)量同時(shí)進(jìn)行，沒(méi)有一個(gè)額外的按鈕 ? Setting and measuring simultaneously ? 黃色 LED指示每一個(gè)脈沖電流 ? Yellow LED indicate every impulse current ? 如果電流量低于設(shè)置值快速閃爍 ? Flashing when the current below setting Stimuplex HNS II 對(duì)不同電流及頻率設(shè)定了不同的聲音提示 ,可調(diào)電流范圍，刺激頻率，刺激時(shí)間 ,在不同類型神經(jīng)刺激時(shí)可更為精確。其特殊的設(shè)計(jì)使操作者可進(jìn)行單人操作，在導(dǎo)針刺入前還能進(jìn)行體表定位，便于在教學(xué)中應(yīng)用。 ?Different current and frequency with different voice ?Changes in current, stimulating frequency and time make the stimulation more precise in different nerves ?Special design for single operation ?Skin location before needle insertion which be used in teaching 單人操作裝置 Device for single operation “神經(jīng)刺激筆 ” “ Stimulator pen” Request for stimulator ? 連續(xù)輸出電流 ? Continuous electrical current ? 可調(diào)輸出電流范圍 (刻度顯示數(shù)字 ) ? Regulated current with digital scale showing ? 清晰的電流極性標(biāo)記 ? Clear current polarity marker ? 刺激頻率較短 ? Short stimulating frequency 各種神經(jīng)刺激器 Nerve stimulators CC：恒定電流 Constant current CV：恒定電壓 Constant voltage Hadzic A, et al. Anesthesiology,2022。98:969. 刺激波形 Stimulating waves （ ， 1kΩ） 升壓時(shí)間與降壓時(shí)間比較 (1mA) Ascending and descending time(1mA) 電流持續(xù)時(shí)間 Current maintenance time 穩(wěn)定的電流輸出可以增加操作 的準(zhǔn)確性，減少病人的創(chuàng)傷 Stable current output improve