【文章內(nèi)容簡介】 operation veracity and reduce patients damages 輸出電流與設定電流誤差比較 Comparison of error between output and initialized current New nerve stimulators could autoregulate the resistance and guarantee the stable current while avoid overshoot voltage Individual body is of different impedance which causes current changes under the same voltage. As provide stable current, supplementary voltage should be given. It may reach 70V and burn the patients. 最大電壓輸出 Maximal voltage output 新型神經(jīng)刺激器多具有參考電極發(fā)生器,能自動調(diào)節(jié)電阻大小,保證輸出電流的衡定，可避免回路電壓過高 New nerve stimulators could autoregulate the resistance and guarantee the stable current while avoid overshoot voltage 生物組織阻抗不同 ,設定相同電壓 ,可能引起電流大小變化 ,據(jù)歐姆定律：I＝ U/R，阻抗變化時，為保證輸出衡電流，需調(diào)整電壓，阻抗不同，差異很大， 70V，會造成病人灼熱痛感新型神經(jīng)刺激器具有參考電極發(fā)生器 ,自動調(diào)節(jié)電阻大小 ,保證輸出衡定電流，避免回路電壓過高 3. 神經(jīng)刺激器使用方法 Nerve block with stimulator 具體定位操作步驟 Operating steps in details ? 測試神經(jīng)刺激器性能 ? Test the stimulator before using ? 安置皮膚電極，保證接觸良好 ? Settle the skin electrode ? 消毒、局麻，但淺表神經(jīng)不必過度浸潤 ? Sterilization, surface anesthesia ? 將局麻藥充滿阻滯針，接地導線接電極 ? Fulfill the block needle with anesthetics and connect the earthing electrode ? 開啟刺激器，調(diào)整參數(shù) :脈寬 ，頻率 2Hz，刺激電流 ? Turn on stimulator and initialize the parameters ? 穿透皮膚、將穿刺針置入皮下組織 ? Perate skin and insert it into subcutaneous tissue ? 電流 ，減小電流 ? Decrease the current after muscle response induced by ? 電流 ~()還可引出肌肉收縮時表明針頭已接近該神經(jīng) , ? The muscle twitch remains at ~() indicates the approach of needle to nerve. current may hurt the nerve. ? 在上述電流下，運動纖維可被 刺激，不影響痛覺纖維、病人舒適，當刺激感覺神經(jīng)時脈寬應 ?，患者可感覺到神經(jīng)支配區(qū)域的異感 ? Motor nerve may be selectively stimulated at without affecting sensory nerve which makes patients fortable. Increasing the impulse time over , the patients will have special feeling at block area. ? 回抽，注入局麻藥 23ml,肌肉收縮停止 ? Withdraw before injection of local anesthetics 23ml. Muscle twitch will stop then. (1)刺激臂叢神經(jīng)的肌肉運動反應 Motor responses after stimulation of brachial plexus nerve 臂叢神經(jīng)運動支配區(qū)域 Brachial plexus nerve domination 外周神經(jīng) Peripheral n. 支配肌肉 Dominating m. 功能 Function 腋神經(jīng) Axillary n. 三角肌 Deltoid m. 肩關(guān)節(jié)處上臂外展 Extension of arm 肌皮神經(jīng) Musculocutaneous n. 肱二頭肌 Biceps m. 喙肱肌 Coracobrachial 旋后位屈肘 Supination and flexion of elbow 正中神經(jīng) Median n. 橈側(cè)腕屈肌 carpi radialis 拇短屈肌 m. flexor pollicis brevis 第 I~III指深屈肌 I~III deep flexor m. of fingers 橈側(cè)腕屈和外展 Flexion and extension of wrist 前臂旋前 (屈近節(jié)指間關(guān)節(jié) )Pronation of forearm and flexion of approximate interpharlangeal joint 屈和外展拇指，屈第 I~III指 (屈遠節(jié)指間關(guān)節(jié) )Flexion and abduction of thumb, flexion of I~III distal interpharlangeal joint 橈神經(jīng) Radial 肱三頭肌 triceps 橈側(cè)腕 (短 )伸肌 carpi radialis brevis 指伸肌 Extensor of fingers 伸肘 Extension of elbow 橈側(cè)腕伸和外展 Extension and abduction of wrist 伸手和手背屈 Abduction and dorsal flexion of hand 指的伸展 Extension of fingers 尺神經(jīng) Ulnar n. 尺側(cè)腕屈肌 Ulnar flexor of wrist 第 IV~V指伸屈肌 IV～ V flexor of fingers 尺側(cè)腕屈和外展 Flexion and abduction of wrist 屈第 IV~V指 Flexion of IV～V fingers 刺激尺神經(jīng)的運動反應 Motor response after stimulation of ulnar nerve Ulnar extension of wrist Flexion of metacarpopharlangeal joint Adduction of thumb 刺激橈神經(jīng)的運動反應 Motor response after stimulation of radial nerve Dorsal flexion of wrist Extension of metacarpo pharlangeal joint Abduction of thumb (2)刺激腰叢與坐骨神經(jīng) 的肌肉運動反應 Motor responses after stimulation of lumbar plexus and sciatic nerve 腰骶叢神經(jīng)運動支配區(qū)域 Lumbarsacral plexus nerve domination 外周神經(jīng) Peripheral n. 支配肌肉 Dominating m. 功能