Ultrasound guidance for transforaminal percutaneous endoscopic lumbar discectomy may preve

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探讨B超引导在急诊重症患者连续肾脏替代治疗股静脉血滤管留置中

中国医疗设备 2017年第32卷 03期 V OL.32 No.0332RESEARCH WORK论著探讨B 超引导在急诊重症患者连续肾脏替代治疗股静脉血滤管留置中的临床价值及安全性Discussion on the Clinical Value and Safety of B Ultrasound-Guided Treatment of Femoral Vein Blood Filter Tube Indwelling Upon the Emergency Patient Receiving Continuous Renal Replacement Therapy[摘要] 目的探究B 超引导在急诊连续肾脏替代治疗（Continuous Renal Replacement Therapy ，CRRT ）股静脉血滤管留置中的作用效果以及安全性，并分析其应用于临床的价值，为疾病的治疗康复提出指导。

方法回顾性选取2015年1月～2016年1月期间，我院急诊收治的CRRT 患者共128例，按照随机数表法将其分为对照组（64例）和观察组（64例），对照组采用B 超引导，而观察组采用常规盲穿，记录两组患者治疗的结果以及安全性，并对记录数据作统计学的处理分析。

结果观察组的一次穿刺成功率，置管成功率，手术操作时间以及不良反应等情况均要好于对照组，差异具有统计学意义（P <0.05）。

结论相比于常规盲穿的方法，B 超引导在急诊CRRT 患者治疗中效果显著，手术操作时间短，置管成功率高，同时不良反应少，安全性好，适合在临床上推广使用，广大医学研究人员应当予以关注。

[关键字] B 超引导；连续肾脏替代治疗；股静脉血滤管留置；连续血液净化疗法；急性肾衰Abstract: Objective To explore the clinical value of B ultrasoundguided treatment so as to provide guidance for the continuous renal replacement therapy, this study analyzed the effect and safety of B ultrasoundguided treatment of femoral vein blood filter tube indwelling upon the emergency patient who receives Continuous Renal Replacement Therapy (CRRT). Methods 128 patients who received CRRT during January, 2015 and January, 2016 were selected and reviewed. They were randomly divided into the control group (64 cases) and the observation group (64 cases). Patients of the control group were conducted B ultrasound-guided treatment and those of the observation group adopted conventional blind wear treatment. The treatment results and safety of both groups were recorded and the data were statistically analyzed. Results In the observation group, the onetime puncture success rate, catheterization success rate, operation time and adverse reactions were better than those of the control group, the differences were statistically significant (P <0.05). Conclusion Compared with the conventional blind wear, B ultrasoundguided treatment upon patients with continuous renal replacement therapy achieved notable effect for it had short operation time, high intubation success rate and good safety, while fewer adverse reaction. It is worth to be paid much attention by the medical researchers to promote its clinical application.Key words: B ultrasound-guided; continuous renal replacement therapy; femoral vein blood filter tubeindwelling; continuous blood purification therapy; acute renal failure [中图分类号] R459.5 [文献标识码] A doi ：10.3969/j.issn.16741633.2017.03.009[文章编号] 1674-1633(2017)03-0032-03刘晓玲内蒙古医科大学附属医院急诊科，内蒙古呼和浩特 010059LIU Xiao-lingDepartment of Emergency, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot Inner Mongolia 010059, China收稿日期：20160412修回日期：20160516作者邮箱：moshivr@RESEARCH WORK论著引言连续肾脏替代治疗（Continuous Renal Replacement Therapy，CRRT）又称之为连续血液净化疗法（Continue Blood Purification Therapy，CBPT），是治疗急诊重症患者的一种良好的方法[12]，在整个危重病医学及中毒急救医学领域均具有广泛的应用。

超声引导下股神经阻滞联合全身麻醉对全膝关节置换患者疼痛及炎症反应的影响

- 61 -①福建中医药大学附属宁德中医院　福建　宁德　352100超声引导下股神经阻滞联合全身麻醉对全膝关节置换患者疼痛及炎症反应的影响郑锦平①【摘要】　目的：探究超声引导下股神经阻滞联合全身麻醉对全膝关节置换患者疼痛及炎症反应的影响。

方法：选择2021年1月—2022年12月福建中医药大学附属宁德中医院收治的100例全膝关节置换患者。

根据随机数表法分为对照组和观察组，各50例。

对照组进行全身麻醉干预，观察组则进行超声引导下股神经阻滞联合全身麻醉干预。

比较两组的不良反应发生率、手术前后的疼痛评分[视觉模拟评分法（VAS）评分]、机械疼痛阈值、疼痛因子[血清P 物质（SP）、前列腺素E 2（PGE 2）]及炎症反应指标[血清C 反应蛋白（CRP）及肿瘤坏死因子-α（TNF-α）]。

结果：两组各项不良反应发生率比较，差异无统计学意义（P >0.05）。

术前，两组静息及运动状态下VAS 评分、机械疼痛阈值、疼痛因子及炎症反应指标比较，差异无统计学意义（P >0.05）；术后2 h、6 h、12 h 及24 h，观察组静息及运动状态下VAS 评分显著低于对照组，机械疼痛阈值显著高于对照组，差异有统计学意义（P <0.05）；术后12 h、24 h 及48 h，观察组SP、PGE 2、CRP、TNF-α显著低于对照组，差异有统计学意义（P <0.05）。

结论：超声引导下股神经阻滞联合全身麻醉可有效控制全膝关节置换患者的疼痛程度，且可显著改善疼痛及炎症反应。

【关键词】　超声引导下股神经阻滞　全身麻醉　全膝关节置换　疼痛　炎症反应 doi：10.14033/ki.cfmr.2024.10.015 文献标识码　B 文章编号　1674-6805（2024）10-0061-05 Influence of Ultrasound-guided Femoral Nerve Block Combined with General Anesthesia for Pain and Inflammatory Reactions of Patients with Total Knee Arthroplasty/ZHENG Jinping. //Chinese and Foreign Medical Research, 2024, 22(10): 61-65 [Abstract]　Objective: To explore the effects of ultrasound-guided femoral nerve block combined with general anesthesia on pain and inflammation in patients with total knee replacement. Method: A total of 100 total knee replacement patients admitted to Ningde Hospital of Traditional Chinese Medicine Affiliated to Fujian University of Traditional Chinese Medicine from January 2021 to December 2022 were selected. They were divided into control group and observation group according to random number table method, with 50 cases in each group. The control group received general anesthesia intervention, and the observation group received ultrasound-guided femoral nerve block combined with general anesthesia intervention. The incidence of adverse reactions, pain scores [visual analogue score (VAS)], mechanical pain threshold, pain factors [serum substance P (SP), prostaglandin E 2 (PGE 2)] and inflammatory response indicators [serum C-reactive protein (CRP), tumor necrosis factor-α (TNF-α)] before and after surgery were compared between the two groups. Result: There were no significant differences in the incidence of adverse reactions between the two groups (P >0.05). Before surgery, there were no significant differences in VAS score at rest and exercise, mechanical pain threshold, pain factor and inflammatory response index between the two groups (P >0.05). At 2 h, 6 h, 12 h and 24 h after surgery, the VAS score at rest and exercise in the observation group were significantly lower than those in the control group, and the mechanical pain threshold were significantly higher than those in the control group, the differences were statistically significant (P <0.05). At 12 h, 24 h and 48 h after surgery, SP, PGE 2, CRP and TNF-α in observation group were significantly lower than those in control group, the differences were statistically significant (P <0.05). Conclusion: Ultrasound-guided femoral nerve block combined with general anesthesia can effectively control the pain degree of patients with total knee replacement, and can significantly improve the pain and inflammation response. [Key words]　Ultrasound-guided femoral nerve block　General anesthesia　Total knee arthroplasty　Pain　Inflammatory response First-author's address: Ningde Hospital of Traditional Chinese Medicine Affiliated to Fujian University of Traditional Chinese Medicine, Ningde 352100, China 全膝关节置换是骨科常见术式，其可有效改善患者的膝关节功能，是临床应用率不断提升的一类治疗方式。

abdominal ultrasound

AIUM Practice Guideline for the Performance of an Ultrasound Examination of the Abdomen and/orRetroperitoneum© 2008 by the American Institute of Ultrasound in MedicineI. IntroductionThe clinical aspects of this guideline (Indications/ Contraindications, Specifications for Individual Examinations, and Equipment Specifications) were developed collaboratively by the American Instituteof Ultrasound in Medicine (AIUM) and the American College of Radiology (ACR). Recommendations for personnel requirements, written request for the exami-nation, procedure documentation, and quality control vary between the two organizations and are addressed by each separately.This guideline has been developed to assist practitioners performing ultrasound studies of the abdomen and/or retroperitoneum. An ultrasound examination is a proven and useful procedure for the evaluation of many struc-tures within these anatomic areas. Depending on the clinical indications, an examination may include the entirety of the abdomen and/or retroperitoneum, a single organ, or several organs. A combination of struc-tures may be imaged because of the location (eg, upper abdominal scan and right upper quadrant organs) or function (eg, biliary system [liver, gallbladder, and bile ducts] and both kidneys). For some patients, more focused examinations may be appropriate for evaluating specific clinical indications or to follow a known abnor-mality. In some cases, additional and/or specialized examinations may be necessary (eg, spectral, color,and/or power Doppler). While it is not possible to detect every abnormality using an ultrasound examination of the abdomen and/or retroperitoneum, adherence to the following guideline will maximize the probabilityof detecting abnormalities.Throughout this guideline, references to Doppler evaluation may include spectral, color, or power Doppler individually or in any combination. Whenever a long-axis view is indicated, it couldbe either a sagittal or coronal plane.(For pediatric considerations, see sections V.A.2, V.A.5, V.B.3, and VII.)II.Qualifications and Responsibilities of PersonnelSee the AIUM Official Statement Training Guidelines for Physicians Who Evaluate and Interpret Diagnostic Ultrasound Examinations and the AIUM Standards and Guidelines for the Accreditation of Ultrasound Practices.III.Indications/Contraindications Indications for an ultrasound examination of the abdomen and/or retroperitoneum include but are not limited to:A.Abdominal, flank, and/or back pain.B.Signs or symptoms that may be referred from theabdominal and/or retroperitoneal regions such asjaundice or hematuria.C.Palpable abnormalities such as an abdominal massor organomegaly.D.Abnormal laboratory values or abnormal findingson other imaging examinations suggestive ofabdominal and/or retroperitoneal pathology.E.Follow-up of known or suspected abnormalities inthe abdomen and/or retroperitoneum.F.Search for metastatic disease or an occult primaryneoplasm.G.Evaluation of suspected congenital abnormalities.H.Abdominal trauma.I.Pre- and post-transplantation evaluation.J.Planning and guidance for an invasive procedure. K.Search for the presence of free or loculated peri-toneal and/or retroperitoneal fluid.An abdominal and/or retroperitoneal ultrasound examination should be performed when there is a valid medical reason. There are no absolute contraindi-cations.IV. Written Request for the Examination The written or electronic request for an ultrasound examination should provide sufficient information to allow for the appropriate performance and interpreta-tion of the examination.The request for the examination must be originated by a physician or other appropriately licensed health care provider or under their direction. The accompanying clinical information should be provided by a physician or other appropriate health care provider familiar with the patient’s clinical situation and should be consistent with the relevant legal and local health care facility requirements.Original copyright 1994; revised 2008, 2007, 2002—AIUM PRACTICE GUIDELINES—Abdomen and/or Retroperitoneum Ultrasound1V. Specifications for IndividualExaminationsDoppler ultrasound may be useful to differentiate vascular from nonvascular structures in any location. Measurements should be considered for any abnormal area.A. Abdomen1.LiverThe examination of the liver should include long-axis and transverse views. The liver parenchyma should be evaluated for focal and/or diffuse abnormalities. If pos-sible, the echogenicity of the liver should be compared with that of the right kidney. In addition, the following should be imaged:a.The major vessels in the region of the liver, includ-ing the inferior vena cava (IVC), the hepatic veins,the main portal vein, and, if possible, the right andleft branches of the portal vein.b.The hepatic lobes (right, left, and caudate) and, ifpossible, the right hemidiaphragm and the adjacent pleural space.c.For vascular examinations of the native or trans-planted liver, Doppler evaluation should be usedto document blood flow characteristics and bloodflow direction. The structures that may be examined include the hepatic arteries, hepatic veins, portalveins, the intrahepatic portion of the IVC, collateral venous pathways, and transjugular intrahepaticportosystemic shunt stents.2. Gallbladder and Biliary TractThe gallbladder evaluation should include long-axis and transverse views obtained in the supine position; other positions, such as left lateral decubitus, erect, and prone positions, may be necessary to evaluatethe gallbladder and its surrounding area completely, particularly when stones and/or sludge are observed. Measurements may aid in determining gallbladder wall thickening. If the patient presents with pain, ten-derness to transducer compression should be assessed. The intrahepatic ducts can be evaluated by obtaining views of the liver demonstrating the right and left branches of the portal vein. Doppler imaging may be used to differentiate hepatic arteries and portal veins from bile ducts. The intrahepatic and extrahepatic bile ducts should be evaluated for dilatation, wall thicken-ing, intraluminal findings, and other abnormalities. The size of the bile duct in the porta hepatis should bedocumented. When visualized, the distal common bile duct in the pancreatic head should be evaluated.A routine gallbladder examination should be conducted on an adequately distended gallbladder. In most cases, fasting for 8 hours before the examination will permit adequate distension of a normally functioning gallblad-der in adults and children. In infants and some adults, adequate distention may be achieved in less time.3. PancreasWhenever possible, all portions of the pancreas—head, uncinate process, body, and tail—should be identified. Orally administered water or a contrast agent may afford better visualization of the pancreas. The following should be assessed in the examination of the pancreas:a.Parenchymal abnormalities.b.The distal common bile duct in the region of thepancreatic head.c.The pancreatic duct for dilatation and any otherabnormalities, with dilatation confirmed bymeasurement.d.The peripancreatic region for adenopathy and/orfluid.4. SpleenRepresentative views of the spleen in long-axis and transverse projections should be obtained. Doppler imaging may be used to determine the presence and direction of flow in the splenic vein and artery. Splenic measurement may be helpful in assessing enlargement. Echogenicity of the left kidney should be compared to splenic echogenicity when possible. An attempt should be made to demonstrate the left hemidiaphragm and the adjacent pleural space.5. BowelThe bowel may be evaluated for wall thickening, dilatation, muscular hypertrophy, masses, and other abnormalities. Sonography of the pylorus and sur-rounding structures may be indicated in the evaluation of the vomiting infant. Compression sonography may be necessary to visualize the appendix or other bowel loops. Measurements may aid in determining bowel wall thickening. Color Doppler imaging may be done to assess blood flow.6. Peritoneal FluidEvaluation for free or loculated peritoneal fluid should include documentation of the extent and location of any fluid identified.Original copyright 1994; revised 2008, 2007, 2002—AIUM PRACTICE GUIDELINES—Abdomen and/or Retroperitoneum Ultrasound 2For evaluating peritoneal spaces for bleeding after traumatic injury, particularly blunt trauma, the exami-nation known as focused abdominal sonography for trauma (or focused assessment with sonography for trauma) may be performed.The objective of the abdominal portion of the examination is to analyze the abdomen for free fluid. Longitudinal and transverse plane images shouldbe obtained in the right upper quadrant through the area of the liver with attention to fluid collections peripheral to the liver and in the subhepatic space. Longitudinal and transverse plane images should be obtained in the left upper quadrant through the area of the spleen, with attention to fluid collections peripheral to the spleen. Longitudinal and transverse images should be obtained at the periphery of the left and right abdomen in the areas of the left and right paracolic gutters for evidence of free fluid. Longitudinal and transverse midline images of the pelvis are obtained to evaluate for free pelvic fluid. Analysis through a fluid-filled bladder (which if necessary can be filled through a Foley catheter when possible) may help in the evaluation of the pelvis. 7. Abdominal WallThe examination should include images of the abdominal wall in the location of symptoms or signs. The relationship of any identified mass to the peri-toneum should be demonstrated. Any defect in the peritoneum and abdominal wall musculature should be documented. The presence or absence of bowel, fluid, or other tissue contained within any abdominal wall defect should be noted. Images obtained in the upright position and/or with use of the Valsalva maneuver may be helpful. A Doppler examination may be useful to define the relationship of blood vessels to a detected mass.B. Retroperitoneum1. KidneysThe examination should include long-axis and trans-verse views of the upper poles, midportions, and lower poles of the kidneys. The cortex and renal pelvises should be assessed. A maximum measurement of renal length should be recorded for both kidneys. Decubitus, prone, or upright positioning may provide better images of the kidneys. When possible, renal echogenicity should be compared to echogenicity of the adjacent liver or spleen. The kidneys and perirenal regions should be assessed for abnormalities.For vascular examination of the kidneys, Doppler imaging can be used:a.T o assess renal arterial and venous patency.b.T o evaluate adults suspected of having renal arterystenosis. For this application, angle-adjustedmeasurements of the peak systolic velocity shouldbe made proximally, centrally, and distally in theextrarenal portion of the main renal arteries whenpossible. The peak systolic velocity of the adjacentaorta (or iliac artery in transplanted kidneys) shouldalso be documented for calculating the ratio of renalto aortic peak systolic velocity. Spectral Doppler evalu-ation of the intrarenal arteries from the upper andlower portions of the kidneys, obtained to evaluatethe early systolic peak, may be of value as indirectevidence of proximal stenosis in the main renal artery.2. Urinary Bladder and Adjacent StructuresWhen performing a complete ultrasound evaluation of the urinary tract, transverse and longitudinal images of the distended urinary bladder and its wall should be included, if possible. Bladder lumen or wall abnormalities should be noted. Dilatation or other distal ureteral abnormalities should be documented. Transverse and longitudinal scans may be used to demonstrate any postvoid residual, which may be quantitated and reported.3. Adrenal GlandsWhen possible, usually in the neonate or young infant, long-axis and transverse images of the adrenal glands may be obtained. The adrenal glands are infrequently seen in adults. When visualized, the size of the gland should be documented, as well as the presence of hem-orrhage, masses, or other abnormalities.4. AortaRepresentative images of the aorta in longitudinal and transverse planes should be obtained as appropriate. When evaluation of the aorta is specifically requested, see the AIUM Practice Guideline for the Performance of Diagnostic and Screening Ultrasound Examinations of the Abdominal Aorta.5. Inferior Vena CavaTransverse and longitudinal images of the IVC should be obtained. Patency and abnormalities may be evaluated with Doppler imaging. Vena cava filters, interruption devices, or catheters may need to be localized with respect to the hepatic and/or renal veins.Original copyright 1994; revised 2008, 2007, 2002—AIUM PRACTICE GUIDELINES—Abdomen and/or Retroperitoneum Ultrasound3VI. DocumentationAdequate documentation is essential for high-quality patient care. There should be a permanent record of the ultrasound examination and its interpretation. Images of all appropriate areas, both normal and abnormal, should be recorded. Variations from normal size should be accompanied by measurements. Images should be labeled with the patient identification, facility identifi-cation, examination date, and side (right or left) of the anatomic site imaged. An official interpretation (final report) of the ultrasound findings should be included in the patient’s medical record. Retention of the ultra-sound examination should be consistent both with clinical needs and with relevant legal and local health care facility requirements.Reporting should be in accordance with the AIUM Practice Guideline for Documentation of an Ultrasound Examination.VII. Equipment SpecificationsAbdomen and/or retroperitoneum ultrasound studies should be conducted with real-time scanners, preferably using sector or linear (straight or curved) transducers. The equipment should be adjusted to operate at the highest clinically appropriate frequency, realizing that there is a trade-off between resolution and beam pene-tration. For most preadolescent pediatric patients, mean frequencies of 5 MHz or greater are preferred, and in neonates and small infants, a higher-frequency trans-ducer is often necessary. For adults, mean frequencies between 2 and 5 MHz are most commonly used. When Doppler studies are performed, the Doppler frequency may differ from the imaging frequency. Diagnostic information should be optimized while keeping total ultrasound exposure as low as reasonably achievable. VIII. Quality Control and Improvement, Safety, Infection Control, and PatientEducation ConcernsPolicies and procedures related to quality control, patient education, infection control, and safety should be developed and implemented in accordance with the AIUM Standards and Guidelines for the Accreditation of Ultrasound Practices.Equipment performance monitoring should be in accordance with the AIUM Standards and Guidelines for the Accreditation of Ultrasound Practices.AcknowledgmentsThis guideline was developed by the American Institute of Ultrasound in Medicine (AIUM) in collaboration with the American College of Radiology (ACR), according to the process described in the AIUM Clinical Standards Committee Manual.Principal RevisersHarris L. Cohen, MDJohn P. McGahan, MDCollaborative SubcommitteesAIUMBarbara S. Hertzberg, MDJon W. Meilstrup, MDLaurence Needleman, MDACRBeverly E. Hashimoto, MD, ChairW. Dennis Foley, MDRonald R. T ownsend, MDAIUM Clinical Standards CommitteeMary Frates, MD, ChairBryann Bromley, MD, Vice ChairT eresita Angtuaco, MDMarie De Lange, BS, RDMS, RDCS, RTBrian Garra, MDBarbara Hertzberg, MDStephen Hoffenberg, MDRichard Jaffe, MDAlfred Kurtz, MDJoan Mastrobattista, MDJohn McGahan, MDJon Meilstrup, MDWilliam Middleton, MDThomas Nelson, PhDDavid Paushter, MDCindy Rapp, BS, RDMSMichelle Robbin, MDHenrietta Kotlus Rosenberg, MDEugene T oy, MDLami Yeo, MDOriginal copyright 1994; revised 2008, 2007, 2002—AIUM PRACTICE GUIDELINES—Abdomen and/or Retroperitoneum Ultrasound 4Comments Reconciliation CommitteeJulie K. Timins, MD, CochairBill H. Warren, MD, CochairAlbert L. Blumberg, MDHarris L. Cohen, MDMary C. Frates, MDGretchen A. Gooding, MDBeverly E. Hashimoto, MDDavid C. Kushner, MDPaul A. Larson, MDLawrence A. Liebscher, MDBeatrice L. Madrazo, MDJohn P. McGahan, MDJon W. Meilstrup, MDMatthew S. Pollack, MDCarol M. Rumack, MDReferences1. Babcock DS, Patriquin HB. 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基于超声引导下的股神经与坐骨神经阻滞在老年下肢骨折患者中的应用效果

DOI：10.19368/ki.2096-1782.2023.06.052基于超声引导下的股神经与坐骨神经阻滞在老年下肢骨折患者中的应用效果张维娜，陈美杉，翟小猛新沂市人民医院麻醉科，江苏新沂221400[摘要]目的探究分析基于超声引导下的股神经与坐骨神经阻滞在老年下肢骨折患者中的应用效果。

方法选取2021年1月—2022年1月新沂市人民医院进行手术治疗的老年下肢骨折患者212例为研究对象。

按计算机随机分组法分为干预组与研究组，各106例。

干预组采用腰硬联合麻醉，研究组采用超声引导下的股神经与坐骨神经阻滞麻醉。

比较两组手术患者麻醉前后平均动脉压、心率，神经阻滞起效时间与持续时间，麻醉不良反应发生情况，术前与术后1h时的凝血功能变化。

结果在麻醉前与麻醉后10 min，两组患者的平均动脉压、心率水平对比，差异无统计学意义（P>0.05）。

两组患者的感觉神经阻滞起效时间、感觉神经阻滞持续时间、运动神经阻滞起效时间、运动神经阻滞持续时间对比，差异无统计学意义（P>0.05）。

术中研究组患者低血压、心动过缓、头痛、恶心呕吐等不良反应发生率为6.60%，低于干预组的16.04%，差异有统计学意义（χ2=4.700，P<0.05）。

术后1 h观察组各项凝血功能指标均长于干预组，差异有统计学意义（P<0.05）。

结论同腰硬联合麻醉相比，在老年下肢骨折患者中应用基于超声引导下的股神经与坐骨神经阻滞同样可以保证麻醉效果和患者的基本生命体征，并且能降低术中麻醉不良反应发生风险，延长凝血时间。

[关键词]下肢骨折；超声引导；股神经与坐骨神经阻滞；腰硬联合麻醉；凝血功能；不良反应[中图分类号]R614 [文献标识码]A [文章编号]2096-1782（2023）03(b)-0052-04Application Effect of Ultrasound-guided Femoral Nerve and Sciatic Nerve Block in Elderly Patients with Lower Extremity FracturesZHANG Weina, CHEN Meishan, ZHAI XiaomengDepartment of Anesthesiology, Xinyi People's Hospital, Xinyi, Jiangsu Province, 221400 China[Abstract] Objective To explore and analyze the application effect of ultrasound-guided femoral nerve and sciatic nerve block in elderly patients with lower extremity fractures. Methods A total of 212 elderly patients with lower ex⁃tremity fracture who underwent surgical treatment in Xinyi People's Hospital from January 2021 to January 2022 were selected as the study objects, and were divided into the intervention group and the study group by computer randomized method, with 106 cases in each group. The intervention group was given lumbo-epidural anesthesia, and the study group was given femoral nerve and sciatic nerve block anesthesia under the guidance of ultrasound. The mean arterial pressure, heart rate, the onset and duration of nerve block, the occurrence of adverse reactions to anes⁃thesia, and the changes of coagulation function 1 h before and after anesthesia were compared between the two groups. Results Before anesthesia and 10 min after anesthesia, the mean arterial pressure and heart rate of the two groups were compared, the difference was not statistically significant (P>0.05). The onset time of sensory nerve block, duration of sensory nerve block, duration of motor nerve block and duration of motor nerve block were compared be⁃tween the two groups, the difference was not statistically significant (P>0.05). The incidence of hypotension, bradycar⁃dia, headache, nausea and vomiting in the study group was 6.60%, which was lower than that in the intervention group (16.04%), the difference was statistically significant (χ2=4.700, P<0.05). The indexes of coagulation function in the ob⁃servation group were longer than those in the intervention group 1 h after operation, and the difference was statistically significant (P<0.05). Conclusion Compared with combined spinal-epidural anesthesia, the application of ultrasound-[作者简介] 张维娜（1987-），女，本科，主治医师，研究方向为临床麻醉。

超声引导下周围神经阻滞技术新进展

超声引导下周围神经阻滞技术新进展金荒漠;郭向阳【摘要】超声引导下周围神经阻滞技术目前得到了广泛的认可.与单纯使用神经刺激器相比,超声引导下神经阻滞的成功率更高,耗时更短.超声引导神经阻滞技术近年来得到了较快的发展,但将超声应用于硬膜外麻醉是否可行仍存在争议.超声引导技术并不能显著减少穿刺所致神经损伤的发生率,但与神经刺激器联合使用仍能改善神经阻滞操作的安全性.【期刊名称】《中国继续医学教育》【年(卷),期】2011(003)010【总页数】8页(P51-58)【关键词】超声;周围神经阻滞;神经刺激器;局部麻醉;神经损伤【作者】金荒漠;郭向阳【作者单位】北京大学第三医院麻醉科;北京大学第三医院麻醉科【正文语种】中文安全、便捷、有效和快速的医疗工作是现代医学的核心内容，麻醉科的许多临床工作针对的是病人的神经系统和心血管系统，怎样在高效运转的医疗模式下保证医疗质量，是摆在麻醉学从业人员面前的严峻问题。

目前，以超声技术为代表的诸多可视化技术使麻醉学科逐渐摆脱了“盲目”操作的时代，进入到可视化操作的新纪元。

超声技术是近年来发展最快、认可度最高的可视化技术。

它对医疗效率和医疗质量的提高起到了极大的推动作用，改善了临床麻醉操作的水平，将麻醉学带入了一个崭新的时代。

麻醉超声技术包括超声引导神经阻滞技术、经食道超声心动图技术（TEE）、经颅多普勒技术、以及超声引导下的动静脉穿刺等等。

其中超声引导周围神经阻滞技术近年来以令人惊讶的速度得到了人们的认可，值得我们在下面进一步阐述。

1 超声引导技术与应用神经刺激器在外周神经阻滞研究进展周围神经阻滞技术自发明以来已经有多种辅助方法，如超声引导[1]、透视引导[2]、神经刺激[3]和筋膜突破音[4]等，从最初的寻找异感法，到神经刺激器的广泛使用，再到超声引导辅助神经刺激器，周围神经阻滞技术的安全性和有效性经历了逐步提高的发展过程。

近年来有多项研究对神经刺激器或超声引导技术进行了比较，有证据显示，单纯通过神经刺激方法引导置管对改善下肢的镇痛效果作用很小[5-6]。

超声引导下神经阻滞的标准

超声引导下神经阻滞的标准Ultrasound-guided nerve blockade is a standard technique used in regional anesthesia to provide targeted pain relief during surgical procedures or for postoperative pain management. This procedure involves the use of ultrasound imaging to visualize the nerves and surrounding structures, allowing for precise needle placement and accurate delivery of local anesthetic agents. The following paragraphs will discuss the importance of ultrasound guidance in nerve blockade from various perspectives.From a patient's perspective, ultrasound-guided nerve blockade offers several advantages. Firstly, it enhances the safety of the procedure by minimizing the risk of complications such as accidental puncture of blood vessels or neighboring organs. The real-time visualization provided by ultrasound allows the anesthesiologist to accurately identify the target nerve and avoid potential hazards. This reduces the likelihood of adverse events and improves patient outcomes.Furthermore, ultrasound guidance improves the efficacyof nerve blockade. By visualizing the nerves andsurrounding tissues, the anesthesiologist can precisely target the nerve of interest and ensure optimal needle placement. This results in more effective anesthesia, leading to improved pain control and patient satisfaction. Additionally, ultrasound guidance allows for the deposition of local anesthetic agents in close proximity to the nerve, reducing the required dosage and minimizing systemic side effects.From the perspective of the anesthesiologist,ultrasound-guided nerve blockade offers increased accuracy and confidence during the procedure. Traditionally, nerve blocks were performed using landmark-based techniques,which relied on anatomical landmarks and palpation. However, these techniques are often imprecise and can lead to inconsistent results. With ultrasound guidance, the anesthesiologist can directly visualize the nerve, needle, and local anesthetic spread, ensuring accurate placementand optimal distribution of the anesthetic agent.Moreover, ultrasound guidance allows for real-time adjustments and refinements during the procedure. If the initial needle placement does not result in the desired spread of local anesthetic, the anesthesiologist can modify the approach and redirect the needle under direct visualization. This dynamic process ensures that the nerve blockade is performed with precision and adaptability, maximizing the chances of success.From a healthcare system perspective, ultrasound-guided nerve blockade has the potential to reduce healthcare costs. By improving the accuracy and efficacy of nerve blocks, ultrasound guidance can lead to better pain control and reduced reliance on systemic analgesics. This not only improves patient comfort but also decreases the length of hospital stays and the need for additional interventions. Additionally, the reduction in complications associatedwith nerve blockade performed without ultrasound guidance can result in cost savings by avoiding the need for subsequent treatments or interventions to address these complications.In conclusion, ultrasound-guided nerve blockade has become the standard technique for regional anesthesia due to its numerous benefits. From the patient's perspective, it enhances safety and improves pain control, leading to better outcomes and increased satisfaction. For the anesthesiologist, ultrasound guidance provides accuracy, confidence, and the ability to make real-time adjustments. From a healthcare system standpoint, ultrasound-guided nerve blockade has the potential to reduce costs by improving pain management and minimizing complications. Overall, this technique has revolutionized the field of regional anesthesia and continues to be a valuable tool in providing effective and safe pain relief.。

超声增强的输送的物料进入并通过皮肤翻译

Ultrasound-enhanced delivery of materials into and through the skinA method for enhancing the permeability of the skin or other biological membrane to a material such as a drug is disclosed. In the method, the drug is delivered in conjunction with ultrasound having a frequency of above about 10 MHz. The method may also be used in conjunction with chemical permeation enhancers and/or with iontophoresis.图片(11)权利要求(21)We claim:1. A method for enhancing the rate of permeation of a drug medium into a selected intact area of an individual's body surface, which method comprises:(a) applying ultrasound having a frequency of above 10 MHz to said selected area, at an intensity and for a period of time effective to enhance the permeability of said selected area;(b) contacting the selected area with the drug medium; and(c) effecting passage of said drug medium into and through said selected area by means of iontophoresis.2. The method of claim 1, wherein said ultrasound frequency is in the range of about 15 MHz to 50 MHz.3. The method of claim 2, wherein said ultrasound frequency is in the range of about 15 to 25 MHz.4. The method of claim 1, wherein said period of time is in the range of about 5 to 45 minutes.5. The method of claim 4, wherein said period of time is in the range of about 5 to 30 minutes.6. The method of claim 1, wherein said period of time is less than about 10 minutes.7. The method of claim 1, wherein said intensity of said ultrasound is less than about 5.0W/cm.sup.2.8. The method of claim 7, wherein said intensity of said ultrasound is in the range of about 0.01 to 5.0 W/cm.sup.2.9. The method of claim 8, wherein said intensity of said ultrasound is in the range of about 0.05 to 3.0 W/cm.sup.2.10. The method of claim 1, wherein said area of the stratum corneum is in the range of about 1 to 100 cm.sup.2.11. The method of claim 10, wherein said area of the stratum corneum is in the range of about 5 to 100 cm.sup.2.12. The method of claim 11, wherein said area of the stratum corneum is in the range of about 10 to 50 cm.sup.2.13. The method of claim 1 wherein said drug medium comprises a drug and a coupling agent effective to transfer said ultrasound to the body from an ultrasound source.14. The method of claim 13 wherein said coupling agent is a polymer or a gel.15. The method of claim 13 wherein said coupling agent is selected from the group consisting of glycerin, water, and propylene glycol.16. The method of claim 1 wherein said drug medium further comprises a chemical permeation enhancer.17. The method of claim 1, wherein steps (a) and (b) are carried out approximately simultaneously.18. The method of claim 1, wherein step (b) is carried out before step (a).19. The method of claim 1, wherein step (a) is carried out before step (b).20. The method of claim 1, wherein the ultrasound is applied continuously.21. The method of claim 1, wherein the ultrasound is pulsed.说明This application is a division of application Ser. No. 07/844,732 filed Mar. 2, 1992, now U.S. Pat. No. 5,231,975 which is a divisional of application Ser. No. 07/484,560, now U.S. Pat. No. 5,115,805, filed Feb. 23, 1990.TECHNICAL FIELDThis invention relates generally to the field of drug delivery. More particularly, the invention relates to a method of enhancing the rate of permeation of topically, transmucosally or transdermally applied materials using high frequency ultrasound.BACKGROUNDThe delivery of drugs through the skin ("transdermal drug delivery" or "TDD") provides many advantages; primarily, such a means of delivery is a comfortable, convenient and non-invasive way of administering drugs. The variable rates of absorption and metabolism encountered in oral treatment are avoided, and other inherent inconveniences--e.g., gastrointestinal irritation and the like--are eliminated as well. Transdermal drug delivery also makes possible a high degree of control over blood concentrations of any particular drug.Skin is a structurally complex, relatively impermeable membrane. Molecules moving from the environment into and through intact skin must first penetrate the stratum corneum and any material on its surface. They must then penetrate the viable epidermis, the papillary dermis, and the capillary walls into the blood stream or lymph channels. To be so absorbed, molecules must overcome a different resistance to penetration in each type of tissue. Transport across the skin membrane is thus a complex phenomenon. However, it is the stratum corneum, a layer approximately 5-15 micrometers thick over most of the body, which presents the primary barrier to absorption of topical compositions or transdermally administered drugs. It is believed to be the high degree of keratinization within its cells as well as their dense packing and cementation by ordered, semicrystalline lipids which create in many cases a substantially impermeable barrier to drug penetration. Applicability of transdermal drug delivery is thus presently limited, because the skin is such an excellent barrier to the ingress of topically applied materials. For example, many of the new peptides and proteins now produced as a result of the biotechnology revolution cannot be delivered across the skin in sufficient quantities due to their naturally low rates of skin permeability.Various methods have been used to increase skin permeability, and in particular to increase the permeability of the stratum corneum (i.e., so as to achieve enhanced penetration, through the skin, of the drug to be administered transdermally). The primary focus has been on the use of chemical enhancers, i.e., wherein drug is coadministered with a penetration enhancing agent (or "permeation enhancer"). While such compounds are effective in increasing the rate at which drug is delivered through the skin, there are drawbacks with many permeation enhancers which limit their use. For example, many permeation enhancers are associated with deleterious effects on the skin (e.g., irritation). In addition, control of drug delivery with chemical enhancement can be quite difficult.Iontophoresis has also been used to increase the permeability of skin to drugs, and involves (1) the application of an external electric field, and (2) topical delivery of an ionized form of drug (or of a neutral drug carried with the water flux associated with ion transport, i.e., via "electroosmosis"). While permeation enhancement via iontophoresis has, as with chemical enhancers, been effective, there are problems with control of drug delivery and the degree of irreversible skin damage induced by the transmembrane passage of current.The presently disclosed and claimed method involves the use of ultrasound to decrease the barrier function of the stratum corneum and thus increase the rate at which a drug may be delivered through the skin. "Ultrasound" is defined as mechanical pressure waves with frequencies above 20,000 Hz (see, e.g., H. Lutz et al., Manual of Ultrasound: 1. Basic Physical and Technical Principles (Berlin: Springer-Verlag, 1984)).As discussed by P. Tyle et al. in Pharmaceutical Research 6(5):355-361 (1989), drug penetration achieved via "sonophoresis" (the movement of drugs through skin under the influence of an ultrasonic perturbation; see D. M. Skauen and G. M. Zentner, Int. J. Pharmaceutics 20:235-245 (1984)), is believed to result from thermal, mechanical and chemical alteration of biological tissues by the applied ultrasonic waves. Unlike iontophoresis, the risk of skin damage appears to be low.Applications of ultrasound to drug delivery have been discussed in the literature. See, for example: P. Tyle et al., supra (which provides an overview of sonophoresis); S. Miyazaki et al., J. Pharm. Pharmacol. 40:716-717 (1988) (controlled release of insulin from a polymer implant using ultrasound); J. Kost et al., Proceed. Intern. Symp. Control. Rel. Bioact. Mater.16(141):294-295 (1989) (overview of the effect of ultrasound on the permeability of human skin and synthetic membranes); H. Benson et al., Physical Therapy 69(2):113-118 (1989) (effect of ultrasound on the percutaneous absorption of benzydamine); E. Novak, Arch. Phys. Medicine & Rehab. 45:231-232 (1964) (enhanced penetration of lidocaine through intact skin using ultrasound); J. E. Griffin et al., Amer. J. Phys. Medicine 44(1):20-25 (1965) (ultrasonic penetration of cortisol into pig tissue); J. E. Griffin et al., J. Amer. Phys. Therapy Assoc.46:18-26 (1966) (overview of the use of ultrasonic energy in drug therapy); J. E. Griffin et al., Phys. Therapy 47(7):594-601 (1967) (ultrasonic penetration of hydrocortisone); J. E. Griffin et al., Phys. Therapy 48(12):1336-1344 (1968) (ultrasonic penetration of cortisol into pig tissue); J. E. Griffin et al., Amer. J. Phys. Medicine 51(2):62-72 (1972) (same); J. C. McElnay, Int. J. Pharmaceutics 40:105-110 (1987) (the effect of ultrasound on the percutaneous absorption of fluocinolone acetonide); and C. Escoffier et al., Bioeng. Skin 2:87-94 (1986) (in vitro study of the velocity of ultrasound in skin).In addition to the aforementioned art, U.S. Pat. Nos. 4,767,402 and 4,780,212 to Kost et al. relate specifically to the use of specific frequencies of ultrasound to enhance the rate of permeation of a drug through human skin or through a synthetic membrane.While the application of ultrasound in conjunction with drug delivery is thus known, results have for the most part been disappointing, i.e., enhancement of skin permeability has been relatively low.SUMMARY OF THE INVENTIONThe present invention provides a novel method for enhancing the rate of permeation of a given material through a selected intact area of an individual's body surface. The method comprises contacting the selected intact area with the material and applying ultrasound to the contacted area. The ultrasound preferably has a frequency of above about 10 MHz, and is continued at an intensity and for a period of time sufficient to enhance the rate of permeation of the material into and through the body surface. The ultrasound can also be used to pretreat the selected area of the body surface in preparation for drug delivery, or for diagnostic purposes, i.e., to enable non-invasive sampling of physiologic material beneath the skin or body surface.In addition to enhancing the rate of permeation of a material, the present invention involves increasing the permeability of a biological membrane such as the stratum corneum by applying ultrasound having a frequency of above about 10 MHz to the membrane at an intensity and for a period of time sufficient to give rise to increased permeability of the membrane. Once the permeability of the membrane has been increased, it is possible to apply a material thereto and obtain an increased rate of flow of the material through the membrane.It is accordingly a primary object of the invention to address the aforementioned deficiencies of the prior art by providing a method of enhancing the permeability of biological membranes and thus allow for an increased rate of delivery of material therethrough.It is another object of the invention to provide such a method which is effective with or without chemical permeation enhancers.It is still another object of the invention to minimize lag time in such a method and provide a relatively short total treatment time.It is yet another object of the invention to provide such a method in which drug delivery is effected using ultrasound.It is a further object of the invention to enable sampling of tissue beneath the skin or other body surface by application of high frequency (>10 MHz) ultrasound thereto.A further feature of the invention is that it preferably involves ultrasound of a frequency greater than about 10 MHz.Additional objects, advantages and novel features of the invention will be set forth in part in the description which follows, and in part will become apparent to those skilled in the art upon examination of the following, or may be learned by practice of the invention.BRIEF DESCRIPTION OF THE DRAWINGSFIGS. 1A, 1B and 1C are theoretical plots of energy dissipation within the skin barrier versus frequency of applied ultrasound.FIGS. 2, 3 and 4 are graphic representations of the amount of salicylic acid recovered from the stratum corneum after ultrasound treatment at different frequencies.FIGS. 5 and 6 represent the results of experiments similar to those summarized in FIGS. 2, 3 and 4, but with a shorter treatment time.FIGS. 7, 8, 9 and 10 are plots of enhancement versus "tape-strip number," as described in the Example.FIG. 11 illustrates the effect of ultrasound on the systemic availability of salicylic acid following topical application.DETAILED DESCRIPTION OF PREFERRED EMBODIMENTSBefore the present method of enhancing the rate of permeation of a material through a biological membrane and enhancing the permeability of membranes using ultrasound are disclosed and described, it is to be understood that this invention is not limited to the particular process steps and materials disclosed herein as such process steps and materials may, of course, vary. It is alto to be understood that the terminology used herein is used for purpose of describing particular embodiments only and is not intended to be limiting since the scope of the present invention will be limited only by the appended claims.It must be noted that as used in this specification and the appended claims, the singular forms "a", "an" and "the" include plural reference unless the context clearly dictates otherwise. Thus, for example, reference to "a drug" includes mixtures of drugs and their pharmaceutically acceptable salts, reference to "an ultrasound device" includes one or more ultrasound devices of the type necessary for carrying out the present invention, and reference to "the method of administration" includes one or more different methods of administration known to those skilled in the art or which will become known to those skilled in the art upon reading this disclosure.In one aspect of the invention a method is provided for enhancing the permeation of a given material such as a drug, pharmacologically active agent, or diagnostic agent into and/or through a biological membrane on an individual's body surface, which method comprises: (a) contacting the membrane with the chosen material in a pharmacologically acceptable carrier medium; and (b) applying ultrasound of an intensity and for a treatment time effective to produce delivery of the material through the membrane. The material is preferably a drug and it is preferable to obtain a desired blood level of the drug in the individual. The ultrasound is of a frequency and intensity effective to increase the permeability of the selected area to theapplied drug over that which would be obtained without ultrasound. The ultrasound preferably has a frequency of more than 10 MHz, and may be applied either continuously or pulsed, preferably continuously. The ultrasound may be applied to the skin either before or after application of the drug medium so long as administration of the ultrasound and the drug medium is relatively simultaneous, i.e., the ultrasound is applied within about 6, more preferably within about 4, most preferably within about 2 minutes of drug application.The invention is useful for achieving transdermal permeation of pharmacologically active agents which otherwise would be quite difficult to deliver through the skin or other body surface. For example, proteinaceous drugs and other high molecular weight pharmacologically active agents are ideal candidates for transdermal, transmucosal or topical delivery using the presently disclosed method. In an alternative embodiment, agents useful for diagnostic purposes may also be delivered into and/or through the body surface using the present method.The invention is also useful as a non-invasive diagnostic technique, i.e., in enabling the sampling of physiologic material from beneath the skin or other body surface and into a collection (and/or evaluation) chamber.The present invention will employ, unless otherwise indicated, conventional pharmaceutical methodology and more specifically conventional methodology used in connection with transdermal delivery of pharmaceutically active compounds and enhancers.In describing the present invention, the following terminology will be used in accordance with the definitions set out below.A "biological membrane" is intended to mean a membrane material present within a living organism which separates one area of the organism from another and, more specifically, which separates the organism from its outer environment. Skin and mucous membranes are thus included."Penetration enhancement" or "permeation enhancement" as used herein relates to an increase in the permeability of skin to a material such as a pharmacologically active agent, i.e., so as to increase the rate at which the material permeates into and through the skin. The present invention involves enhancement of permeation through the use of ultrasound, and, in particular, through the use of ultrasound having a frequency of greater than 10 MHz."Transdermal" (or "percutaneous") shall mean passage of a material into and through the skin to achieve effective therapeutic blood levels or deep tissue therapeutic levels. While the invention is described herein primarily in terms of "transdermal" administration, it will be appreciated by those skilled in the art that the presently disclosed and claimed method also encompasses the "transmucosal" and "topical" administration of drugs using ultrasound. "Transmucosal" is intended to mean passage of any given material through a mucosal membrane of a living organism and more specifically shall refer to the passage of a materialfrom the outside environment of the organism, through a mucous membrane and into the organism. "Transmucosal" administration thus includes delivery of drugs through either nasal or buccal tissue. By "topical" administration is meant local administration of a topical pharmacologically active agent to the skin as in, for example, the treatment of various skin disorders or the administration of a local anaesthetic. "Topical" delivery can involve penetration of a drug into the skin but not through it, i.e., topical administration does not involve actual passage of a drug into the bloodstream."Carriers" or "vehicles" as used herein refer to carrier materials without pharmacological activity which are suitable for administration with other pharmaceutically active materials, and include any such materials known in the art, e.g., any liquid, gel, solvent, liquid diluent, solubilizer, or the like, which is nontoxic and which does not interact with the drug to be administered in a deleterious manner. Examples of suitable carriers for use herein include water, mineral oil, silicone, inorganic gels, aqueous emulsions, liquid sugars, waxes, petroleum jelly, and a variety of other oils and polymeric materials.By the term "pharmacologically active agent" or "drug" as used herein is meant any chemical material or compound suitable for transdermal or transmucosal administration which can either (1) have a prophylactic effect on the organism and prevent an undesired biological effect such as preventing an infection, (2) alleviates a condition caused by a disease such as alleviating pain caused as a result of a disease, or (3) either alleviates or completely eliminates the disease from the organism. The effect of the agent may be local, such as providing for a local anaesthetic effect or it may be systemic. Such substances include the broad classes of compounds normally delivered through body surfaces and membranes, including skin. In general, this includes: anti-infectives such as antibiotics and antiviral agents; analgesics and analgesic combinations; anorexics; antihelminthics; antiarthritics; antiasthmatic agents; anticonvulsants; antidepressants; antidiabetic agents; antidiarrheals; antihistamines; antiinflammatory agents; antimigraine preparations; antinauseants; antineoplastics; antiparkinsonism drugs; antipruritics; antipsychotics; antipyretics; antispasmodics; anticholinergics; sympathomimetics; xanthine derivatives; cardiovascular preparations including potassium and calcium channel blockers, beta-blockers, and antiarrhythmics; antihypertensives; diuretics; vasodilators including general coronary, peripheral and cerebral; central nervous system stimulants; cough and cold preparations, including decongestants; hormones such as estradiol and other steroids, including corticosteroids; hypnotics; immunosuppressives; muscle relaxants; parasympatholytics; psychostimulants; sedatives; and tranquilizers. By the method of the present invention, both ionized and nonionzed drugs may be delivered, as can drugs of either high or low molecular weight.Proteinaceous and polypeptide drugs represent a preferred class of drugs for use in conjunction with the presently disclosed and claimed invention. Such drugs cannot generally be administered orally in that they Are often destroyed in the G.I. tract or metabolized in the liver. Further, due to the high molecular weight of most polypeptide drugs, conventional transdermal delivery systems are not generally effective. It is also desirable to use the methodof the invention in conjunction with drugs to which the permeability of the skin is relatively low, or which give rise to a long lag-time (application of ultrasound as described herein has been found to significantly reduce the lag-time involved with the transdermal administration of most drugs).By a "therapeutically effective" amount of a pharmacologically active agent is meant a nontoxic but sufficient amount of a compound to provide the desired therapeutic effect. The desired therapeutic effect may be a prophylactic effect, in preventing a disease, an effect which alleviates a system of the disease, or a curative effect which either eliminates or aids in the elimination of the disease.As noted above, the present invention is a method for enhancing the rate of permeation of a drug through an intact area of an individual's body surface, preferably the human skin. The method involves transdermal administration of a selected drug in conjunction with ultrasound. Ultrasound causes thermal, mechanical and chemical alterations of biological tissue, thereby enhancing the rate of permeation of a given material therethrough.While not wishing to be bound by theory, applicants propose that the use of higher frequency ultrasound as disclosed herein specifically enhances the permeation of the drug through the outer layer of skin, i.e., the stratum corneum, by causing momentary and reversible perturbations within (and thus short-term, reversible reduction in the barrier function of) the layer of the stratum corneum. It will be appreciated by those skilled in the art of transdermal drug delivery that a number of factors related to the present method will vary with the drug to be administered, the disease or injury to be treated, the age of the selected individual, the location of the skin to which the drug is applied, and the like.As noted above, "ultrasound" is ultrasonic radiation of a frequency above 20,000 Hz. As may be deduced from the literature cited above, ultrasound used for most medical purposes typically employs frequencies ranging from 1.6 to about 10 MHz. The present invention, by contrast, employs ultrasound frequencies of greater than about 10 MHz, preferably in the range of about 15 to 50 MHz, most preferably in the range of about 15 to 25 MHz. It should be emphasized that these ranges are intended to be merely illustrative of the preferred embodiment; in some cases higher or lower frequencies may be used.The ultrasound may be pulsed or continuous, but is preferably continuous when lower frequencies are used. At very high frequencies, pulsed application will generally be preferred so as to enable dissipation of generated heat.The preferred intensity of the applied ultrasound is less than about 5.0 W/cm.sup.2, more preferably is in the range of about 0.01 to 5.0 W/cm.sup.2, and most preferably is in the range of 0.05 to 3.0 W/cm.sup.2. The total treatment time, i.e., the period over which drug and ultrasound are administered, will vary depending on the drug administered, the disease or injury treated, etc., but will generally be on the order of about 30 seconds to 60 minutes, preferably 5 to 45 minutes, more preferably 5 to 30 minutes, and most preferably 5 to 10minutes. It should be noted that the aforementioned ranges represent suggested, or preferred, treatment times, but are not in any way intended to be limiting. Longer or shorter times may be possible and in some cases desirable. Virtually any type of device may be used to administer the ultrasound, providing that the device is callable of producing the higher frequency ultrasonic waves required by the present method. A device will typically have a power source such as a small battery, a transducer, a reservoir in which the drug medium is housed (and which may or may not be refillable), and a means to attach the system to the desired skin site.As ultrasound does not transmit well in air, a liquid medium is generally needed to efficiently and rapidly transmit ultrasound between the ultrasound applicator and the skin. As explained by P. Tyle et al., cited above, the selected drug medium should contain a "coupling" or "contacting" agent typically used in conjunction with ultrasound. The coupling agent should have an absorption coefficient similar to that of water, and furthermore be nonstaining, nonirritating to the skin, and slow drying. It is clearly preferred that the coupling agent retain a paste or gel consistency during the time period of ultrasound administration so that contact is maintained between the ultrasound source and the skin. Examples of preferred coupling agents are mixtures of mineral oil and glycerine and propylene glycol, oil/water emulsions, and a water-based gel. A solid-state, non-crystalline polymeric film having the above-mentioned characteristics may also be used. The drug medium may also contain a carrier or vehicle, as defined alone.A transdermal patch as well known in the art may be used in conjunction with the present invention, i.e., to deliver the drug medium to the skin. The "patch", however, must have the properties of the coupling agent as described in the preceding paragraph so as to enable transmission of the ultrasound from the applicator, through the patch, to the skin.As noted earlier in this section, virtually any chemical material or compound suitable for transdermal, transmucosal or topical administration may be administered using the present method. Again, the present invention is particularly useful to enhance delivery of proteinaceous and other high molecular weight drugs.The method of the invention is preferably carried out as follows. The drug medium, i.e., containing the selected drug or drugs in conjunction with the coupling agent and optionally a carrier or vehicle material, is applied to an area of intact body surface. Ultrasound preferably having a frequency greater than about 10 MHz may be applied before or after application of the drug medium, but is preferably applied immediately before application of the drug so as to "pretreat" the skin prior to drug administration.It should also be pointed out that the present method may be used in conjunction with a chemical permeation enhancer as known in the art, wherein the ultrasound enables the use of much lower concentrations of permeation enhancer--thus minimizing skin irritation and other problems frequently associated with such compounds--than would be possible in the absence of ultrasound. The permeation enhancer may be incorporated into the drug medium or it may。

超声引导下踝周围神经阻滞技术在足趾畸形矫正术后镇痛效果的研究

表达及其对术后复发的预测价值[J]. 中华耳鼻咽喉头颈外科杂志, 2019, 54(3):174-180.[21] 巴罗, 杜进涛, 蔡舜玉, 等. 不同免疫表型鼻息肉中黏膜炎症模式与组织重塑特征[J]. 临床耳鼻咽喉头颈外科杂志, 2016,30(16):1302-1307.[22] 高英. IL-5及其受体IL-5Rα在慢性鼻-鼻窦炎伴息肉患者息肉组织中的表达及意义[J]. 中国耳鼻咽喉颅底外科杂志, 2016,22(1):51-55.[23] 吕立辉, 康洪涛, 王春河. 炎性细胞因子IL-8对慢性鼻-鼻窦炎伴鼻息肉患者术后复发的预测价值初步探讨[J]. 中国中西医结合耳鼻咽喉科杂志, 2018, 26(2):93-94.[24] 武颖异, 包亚军, 周雯娟, 等. IL-17和VEGF在慢性鼻-鼻窦炎患者鼻息肉组织中的表达及相关性研究[J]. 现代生物医学进展,2018, 18(10):1901-1904.[25] BA L, DU J, LIU F, et al. Distinct inflammatory profiles in atopicand nonatopic patients with chronic rhinosinustis accompanied bynasal polyps in western China[J]. Allergy Asthma Immunol Res,2015, 7(4):346-358.（收稿日期：2020-09-10；修回日期：2020-12-04）（本文编辑：胡全兵）超声引导下踝周围神经阻滞技术在足趾畸形矫正术后镇痛效果的研究陈晨，陶岩，王庚，周雁，张伟，赵尧平（北京积水潭医院麻醉科，北京 100035）摘　要：目的　比较超声引导下踝周围神经阻滞和腘窝入路坐骨神经阻滞在足趾畸形矫正术后的镇痛效果。

方法　选择2019年12月至2020年5月北京积水潭医院80例拟行足趾畸形矫正术患者为研究对象，随机分为超声引导下踝周围神经阻滞组（A组）和腘窝入路坐骨神经阻滞组（P组），每组40例。

超声引导下经颞下窝入路蝶腭神经节注射治疗变应性鼻炎效果分析

DOI:10.16662/ki.1674-0742.2021.10.055超声引导下经颞下窝入路蝶腭神经节注射治疗变应性鼻炎效果分析杨运堂北京市监狱管理局中心医院中医科,北京100036[摘要]目的分析超声引导下经颞下窝入路蝶腭神经节注射治疗变应性鼻炎的临床效果。

方法于2018年10月—2020年1月方便选取240例变应性鼻炎患者为该项研究对象,参照分层抽样分组的方式将其分为对照组、实验组,每组120例。

对照组采用常规药物治疗,实验组则给予超声引导下经颞下窝入路蝶腭神经节注射治疗,注射药物选用复方倍他米松和利多卡因,比较两种治疗方式的临床效果。

结果治疗前,两组鼻塞、鼻痒、流涕和喷嚏等症状评分差异无统计学意义(P>0.05);治疗后,实验组上述各项症状评分均低于对照组,差异有统计学意义(P<0.05);治疗前,两组生活质量评分差异无统计学意义(P>0.05);治疗后,两组较治疗前评分均有所下降,且实验组评分明显低于对照组,差异有统计学意义(P<0.05);实验组不良反应发生率为5.00%,明显低于对照组13.33%,差异有统计学意义(χ2=5.004,P<0.05)。

结论对变应性鼻炎患者采用超声引导下经颞下窝入路蝶腭神经节注射治疗可以对病灶进行精确定位,从而有效缓解患者鼻塞、鼻痒、流涕和喷嚏等临床症状,减少不良反应的发生,在保障患者治疗安全性的同时也有助于改善患者的生活质量。

[关键词]变应性鼻炎;超声引导;蝶腭神经节[中图分类号]R4[文献标识码]A[文章编号]1674-0742(2021)04(a)-0055-04Analysis of the Effect of Ultrasound -guided Sphenopalatine Ganglion Injection through the Infratemporal Fossa in the Treatment of Allergic RhinitisYANG Yuntang Department of Traditional Chinese Medicine,Central Hospital of Beijing Prison Administration Bureau,Beijing,100036China[Abstract]Objective To analyze the clinical effect of ultrasound-guided trans-infratemporal fossa approach sphenopalatine ganglion injection in the treatment of allergic rhinitis.Methods From October 2018to January 2020,240patients with allergic rhinitis were conveniently selected as the research objects,and they were divided into control group and experimental group with reference to the stratified sampling grouping method,with 120cases in each group.The control group was treated with conventional drugs,and the experimental group was given ultrasound -guided trans-infratemporal fossa approach sphenopalatine ganglion injection therapy.The injection drugs were compound betamethasone and lidocaine.The clinical effects of the two treatments were compared.Results Before treatment,there was no statistically significant difference in the scores of symptoms such as nasal congestion,nasal itching,runny nose and sneezing between the two groups (P>0.05);after treatment,the above-mentioned symptoms scores of the experimental group were lower than those of the control group,and the differences were statistically significant(P<0.05).Before treatment,the difference in quality of life scores between the two groups was not statistically significant(P >0.05);after treatment,the scores of the two groupsdecreased compared with those before treatment,and the scores of the experimental group were significantly lower than those of the control group.There was statistical significance (P<0.05);the adverse reaction rate of the experimental groupwas 5.00%,which was significantly lower than the control group 13.33%,and the difference was statistically significant (χ2=5.004,P<0.05).Conclusion Ultrasound -guided trans -infratemporal fossa approach sphenopalatine ganglion injection for patients with allergic rhinitis can accurately locate the lesion,thereby effectively alleviating the clinical symptoms of patients with nasal congestion,nasal itching,runny nose and sneezing,and reducing adverse reactions;the occurrence of[作者简介]杨运堂(1970-),男,本科,副主任医师,研究方向为疼痛科,全科。

周围神经超声英文著作

周围神经超声英文著作Peripheral Nerve Ultrasound: A Valuable Tool in Diagnosis and TreatmentPeripheral nerve ultrasound has emerged as a powerful diagnostic and therapeutic tool in the field of neurology and musculoskeletal medicine. This non-invasive imaging technique allows healthcare professionals to visualize the structure and function of peripheral nerves with remarkable clarity and precision. By leveraging the principles of sound wave propagation, peripheral nerve ultrasound enables clinicians to identify pathologies, guide interventions, and monitor the progress of various neurological and musculoskeletal conditions.One of the primary applications of peripheral nerve ultrasound is the evaluation of nerve entrapment syndromes. Conditions such as carpal tunnel syndrome, cubital tunnel syndrome, and peroneal nerve entrapment can be accurately diagnosed using this imaging modality. Ultrasound allows healthcare providers to assess the size, shape, and echogenicity of the affected nerves, as well as identifyany structural abnormalities or compression points. This information is invaluable in guiding the appropriate treatment approach, whether it be conservative management, targeted injections, or surgical intervention.In addition to nerve entrapment, peripheral nerve ultrasound has proven to be a valuable tool in the assessment of traumatic nerve injuries. By visualizing the anatomical integrity of the nerve, clinicians can determine the extent of the injury and plan the most effective treatment strategy. Ultrasound can help differentiate between complete nerve transection, partial nerve injury, and neuroma formation, allowing for more accurate prognosis and tailored rehabilitation protocols.Another area where peripheral nerve ultrasound has demonstrated its utility is in the evaluation of peripheral neuropathies. Conditions such as diabetic neuropathy, Charcot-Marie-Tooth disease, and chronic inflammatory demyelinating polyneuropathy can be characterized using this imaging technique. Clinicians can assess nerve size, echogenicity, and vascularity to identify patterns of nerve involvement and monitor disease progression or response to treatment.Beyond diagnostic applications, peripheral nerve ultrasound has also become an essential tool in the realm of interventional painmanagement. Ultrasound-guided nerve blocks and injections have become increasingly common, allowing for more precise and targeted delivery of anesthetic or corticosteroid agents. This technique reduces the risk of complications and improves the efficacy of these procedures, leading to better patient outcomes.The versatility of peripheral nerve ultrasound extends to the field of rehabilitation as well. Clinicians can use this imaging modality to guide the placement of neuromuscular electrical stimulation electrodes, ensuring optimal nerve-muscle interaction and improving the effectiveness of rehabilitation programs. Additionally, ultrasound can be employed to monitor the recovery and regeneration of nerves following injury or surgical intervention, providing valuable feedback to guide the rehabilitation process.One of the key advantages of peripheral nerve ultrasound is its accessibility and ease of use. Unlike other imaging modalities, such as magnetic resonance imaging (MRI) or computed tomography (CT), ultrasound equipment is relatively portable and can be readily available in clinical settings. This allows for rapid, bedside evaluation of peripheral nerve pathologies, enabling timely diagnosis and prompt initiation of appropriate treatment.Furthermore, peripheral nerve ultrasound is a cost-effective alternative to more expensive imaging techniques. This is particularlyrelevant in resource-limited settings or healthcare systems with budgetary constraints, where the availability of advanced imaging modalities may be limited. The affordability and portability of ultrasound equipment make it a valuable tool in expanding access to high-quality neurological and musculoskeletal care.Despite its numerous advantages, it is important to recognize that the success of peripheral nerve ultrasound is heavily dependent on the expertise and experience of the healthcare provider performing the examination. Proper training and ongoing education are crucial to ensure accurate interpretation of ultrasound images and the appropriate application of this technology in clinical practice.In conclusion, peripheral nerve ultrasound has emerged as a transformative diagnostic and therapeutic tool in the field of neurology and musculoskeletal medicine. Its ability to visualize the structure and function of peripheral nerves with remarkable clarity has revolutionized the way healthcare professionals approach the assessment and management of a wide range of neurological and musculoskeletal conditions. As the technology continues to evolve and the body of evidence supporting its clinical utility grows, the role of peripheral nerve ultrasound in modern healthcare is poised to expand further, ultimately leading to improved patient outcomes and enhanced quality of care.。

经阴道超声监测卵泡及子宫内膜发育状况可提高受孕率

Transvaginal ultrasound monitoring the development of follicles and endometrium can guide the treatment of infertilityHUANG Yinchun 1,ZENG Linghong 2,XIE Chengwen 3,FAN Xiaomeng 1,CAO Xiao 11School of Medical Imaging,Changsha Medical College,Changsha 410000,China;2Department of Ultrasound,3Department of Obstetrics and Gynecology,The First Affiliated Hospital of Changsha Medical College,Changsha 410000,China摘要：目的分析不孕症患者卵泡及子宫内膜的发育特点，为临床治疗提供准确依据。

方法选取128例不孕症患者设为观察组，128例成功妊娠女性设为对照组。

比较两组月经周期第8、10、12、14天卵泡大小，同时测量并比较观察组与对照组卵泡个数、扁卵泡个数、最大卵泡长与宽度，宫体、宫颈大小及子宫内膜厚度，监测结局。

结果观察组排卵期卵泡个数、卵泡最大直径、卵泡每日增长直径及内膜厚度均低于对照组，差异有统计学意义（P <0.05）；观察组排卵正常型4例，明显低于对照组126例，差异有统计学意义（P <0.05）；观察组卵泡黄体化不破裂型、扁卵泡及无优势卵泡型分别为42例、64例及有84例均明显高于对照组2例、6例及1例，差异有统计学意义（P <0.05）。

观察组B 型内膜的患者中，排卵正常型和排卵异常型分别有1例和18例，明显差于对照组125例和3例，差异有统计学意义（P <0.05）；观察组无优势卵泡的患者中，A 型内膜和C 型内膜分别有76例和7例，明显高于对照组0例和0例，差异有统计学意义（P <0.05）；观察组卵泡黄体化不破裂型的患者中，A 型内膜和C 型内膜分别有11例和15例，明显高于对照组0例和0例，差异有统计学意义（P <0.05）。

超声引导下甲状腺细针穿刺对甲状腺乳头状癌的诊断价值

我国甲状腺癌在近30年时间里发病率提高了近30倍，且发病人群趋于年轻化［1］。

最常见的甲状腺恶性肿瘤即甲状腺乳头状癌（PTC ），占总发病率的80%以上［2］。

PTC 早期缺乏特征性临床症状，患者无明显躯体不适，因而难以实现早期诊断。

随着超声技术的不断发展，以其为基础的多种诊断技术获得广泛运用，超声引导下甲状腺细针穿刺（US-FNAC ）是近年来兴起的对可疑癌结节进行诊断的技术，具有创伤小、操作简单、无针道转移等优势［3］。

既往研究显示，US-FNAC 对甲状腺结节诊断的敏感度达到97.0%；但由于甲状腺结节大小、硬化、囊性病变等不同，穿刺医生操作熟练度差异以及癌结节声像图多样化等因素，US-FNAC 的准确率及阳性率均会受到一定影响［4］。

对于采用US-FNAC 对PTC 进行诊断的相关报道尚不多见，且多为笼统分析，未根据病灶尺寸进行分级探究［5］。

为探究US-FNAC 对于PTC 的诊Diagnostic value of ultrasound-guided fine needle aspiration for papillary thyrid carcinomaDING Wenjun,LIN Fengchun,TAO Yakui,SUN Jianwei,ZHANG Yu Department of Ultrasound,Hefei BOE Hospital,Hefei 230011,China摘要：目的探讨超声引导下甲状腺细针穿刺（US-FNAC ）对甲状腺乳头状癌的诊断价值。

方法选取2015年1月~2022年3月于我院甲状腺外科行甲状腺结节检查患者235例作为研究对象，根据结节最大径将其分为4组：A 组（<5mm ）、B 组（5.1~10mm ）、C 组（10.1~20mm ）、D 组（≥20mm ）。

以病理结果为金标准，统计并记录4组US-FNAC 阳性率、无法确诊率、准确率、阳性预测值、阴性预测值、转移性结节分区情况。

超声英文文献分享

超声英文文献分享以下是一篇关于超声的英文文献分享：Title: The Use of Ultrasound in the Management of Thyroid NodulesUltrasound (US) is a widely used imaging modality that provides valuable information in the evaluation and management of thyroid nodules. US allows for the identification and characterization of thyroid nodules, evaluation of nodule vascularity, and guidance for fine-needle aspiration (FNA). In this article, we discuss the role of US in the diagnosis and management of thyroid nodules, including its advantages, limitations, and future directions.US is a noninvasive, radiation-free, and cost-effective imaging modality that provides real-time information about thyroid nodules. It can identify small nodules that are often missed on palpation and assess the morphology, size, echogenicity, calcifications, and vascularity of thyroid nodules. US-guided FNA is a minimally invasive technique that allows for the histopathological diagnosis of thyroidnodules. It has replaced surgical biopsy as the reference standard for the diagnosis of thyroid nodules.US can be used to differentiate benign from malignant thyroid nodules with variable accuracy. Malignant thyroid nodules are often hypoechoic, have irregular borders, microcalcifications, and increased vascularity on Doppler US. However, there is significant overlap between benign and malignant thyroid nodules on US features, leading to false positives and false negatives. Therefore, US cannot be used alone to diagnose thyroid malignancy.US-guided FNA is indicated for the evaluation of thyroid nodules with suspicious US features or a diameter greater than 1 cm. The Bethesda System for Reporting Thyroid Cytopathology is a widely used classification system for reporting FNA results. It categorizes thyroid nodules as benign, atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS), follicular neoplasm or suspicious for follicular neoplasm (FN/SFN), suspicious for malignancy (SM), or malignant. The risk of malignancy varies with the FNA category and informs clinical management decisions.Management options for thyroid nodules include observation, US-guided FNA, or surgical excision. Management decisions should be individualized based on the risk of malignancy, patient preferences, and local resources. Observation is recommended for benign thyroid nodules with low risk of malignancy. US-guided FNA is indicated for thyroid nodules with suspicious US features or a diameter greater than 1 cm. Surgical excision is indicated for cytologically malignant thyroid nodules or those with high suspicion of malignancy based on US features or growth on serial US surveillance.In conclusion, US plays a crucial role in the evaluation and management of thyroid nodules. It provides valuable information about the morphology and vascularity of thyroid nodules and can guide FNA for histopathological diagnosis. However, US features overlap between benign and malignant thyroid nodules, limiting its diagnostic accuracy. Therefore, US should be used in conjunction with other clinical factors and cytological findings to optimize the diagnosis and management of thyroid nodules. Future research should focus on improving US technology and developing more accurate algorithms for thyroid nodule diagnosis.。

超声波用于介入性疼痛管理说明书

357© Springer Nature Switzerland AG 2020P. Peng et al. (eds.), Ultrasound for Interventional Pain Management , https:///10.1007/978-3-030-18371-4AAbsorption, 5–7, 29Acoustic enhancement artifact, 18, 19Acoustic impedance, 7, 29Acoustic lens, 10Acoustic matching layer, 10Acoustic shadowing, 18, 19, 325Air artifact, 21Alcock’s canal, 100–102, 109, 110, 112Amplitude (A) mode, 5Anisotropy, 21–22, 209Anterior spinal artery, 149, 154Anterior superior iliac spine (ASIS), 75, 77,79, 81, 121, 125, 273, 340, 341Artifactacoustic enhancement artifact, 18acoustic shadowing, 18air artifact, 21anisotropy, 21edge shadowing, 20mirror imaging artifact, 20reverberation artifact, 18Ascending cervical arteries, 149BBeatty test, 96Border nerves, 75, 76Brightness (B), 4, 5CCalcific tendinitis calcific stage, 325causes, 325fenestration technique, 330, 331hard calcific phase, 326hard calcific phases, 325minimal invasive treatments, 325one needle barbotage technique, 328–330patient selection, 327phases of, 326postcalcific stage, 325precalcific stage, 325resorptive phase, 326soft calcific phase, 326ultrasound scan, 327Carpal tunnel syndrome causes, 247diagnosis, 247in-plane injection, 250median nerve, 247out-of-plane injection, 251ultrasound scan, 249Caudal canal injectioncomplications, 203, 204filum terminale and dura, 201needle placement, 199patient selection, 201sacral hiatus, 199, 200ultrasound guidance, 199ultrasound scan, 201–204Cervical epidural space, 150Cervical ganglion trunk, 45Cervical medial branch blocks (CMBBs)anatomy, 158patient selection, 158ultrasound scanC5, C6 medial branches, 164, 165C7 medial branches, 165coronal (long axis) scan, 160, 161needle placement, 165, 166procedure, 164TON, C3, C4 medial branches, 164transverse (short axis) scan, 161, 162Cervical nerve root block/transforaminalepidural injections, 151, 155Cervical spinal nerve, 149Index358Cervical sympathetic trunkclinical benefits, 49, 50contraindications, 46painful and non-painful conditions, 50patient selection, 45procedure, 48–49ultrasound scanning, 46–48Cervical transforaminal injections, 149, 154 Cervicogenic headache, 35, 41 Cervicothoracic ganglion, 43, 45, 50 Chronic pelvic pain (CPP), 93Cluster attacks, 41Color Doppler, 13–16, 46, 47, 165, 271–274 Complex regional pain syndrome (CRPS)type I, 59Cross-body adduction test, 59, 217DDeep cervical arteries, 149–151Deep gluteal syndrome, 100Depth, ultrasound, 12Doppler, 13–16, 37–39, 46, 47, 80, 97, 102,165, 298, 352EEdge shadowing, 20Elbow paincauses, 233lateral elbow anatomy, 234medial elbow anatomy, 235patient selection, 236posterior elbow anatomy, 236ultrasound scanelbow joint injection, 243, 244injection for common extensor tendon, 242injection for common flexor tendon,242, 243lateral elbow, 237medial elbow, 238, 239posterior elbow, 240, 241Electrical stimulation, 2, 95, 99Erector spinae plane (ESP) block, 131, 132 and transverse process, 144blockade area, 136catheter placement, 142clinical benefits, 143ligaments and muscles, 133mechanism of action, 133MRI scan, 134patient selection and the choice oflevel, 135randomized controlled trials, 144, 145single shot injection, 141ultrasound scanning, 137–139 Ergonomics, 23, 25, 27, 28EtOH, 70External iliac artery (EIA), 79, 83, 85–89FFocus, ultrasound, 14Foot and ankle painankle anatomy, 301, 302ankle joint, ultrasound scanprocedure, 312–314subtalar joint, 310–312tibiotalar joint, 310ankle nerves, ultrasound scandeep peroneal nerve, 307procedure, 309sural and superficial peroneal nerve,303–307tibial and saphenous nerve, 308, 309 anterior view of ankle, 303anteromedial view of ankle, 305etiology of, 301lateral view of ankle, 306medial view of ankle, 305musculoskeletal causes, 301patient selection, 303peripheral nerves, 301SaN, 302SuN, 302superficial peroneal nerve, 301, 304ultrasound scan, tibial and saphenousnerve, 309GGain, ultrasound, 13Genitofemoral nerve (GFN), 83clinical benefits, 91genital branch, 85, 91patient selection, 85procedure, 90ultrasound scanning, 85, 87–89Greater occipital nerve (GON)anatomy, 34blockade indication, 33clinical benefits, 40distal approach, 37, 38patient selection, 35procedure, 39, 40proximal approach, 36, 37ultrasound-guided technique, 41Index359HHand-shoulder syndrome (HSS), 59 Hematoma, 69, 203Hemoperitoneum, 69High-Intensity focused ultrasound (HIFU), 70 Hip jointanterior hipiliacus and psoas, 277patient selection, 278procedure, 279ultrasound scan, 278, 279blood supply, 268bones, cartilage, and ligamentousstructures, 267hip greater trochanteric (GT) complexgluteus minimus (GMin), 275muscles and tendons, 275patient selection, 276ultrasound scanning, 276–278hip intraarticular injectionin-plane needle insertion, 274out-plane needle insertion, 273, 274patient selection, 268ultrasound scanning, 270–273innervation, 268musculature, 268Hip painarticular branches of hip, 336, 340AON, 337, 338femoral nerve, 336, 337obturator nerve, 337, 339diagnostic block, 343–345patient selection, 338radiofrequency ablation, 344, 345RFA, 336ultrasound scan, 339–343 Hyperechoic, 15, 17, 29, 101, 114, 138, 139, 208 Hypoechoic, 15, 17, 29, 68, 201, 208, 209,222, 258, 292, 295IIliohypogastric nerves, 75–78clinical benefits, 81external oblique, 75internal oblique, 75patient selection, 77, 78procedure, 80–81techniques, 81ultrasound scanning, 79, 80Ilioinguinal nerves, 75, 76clinical benefits, 81external oblique, 75internal oblique, 75patient selection, 77, 78procedure, 80–81techniques, 81ultrasound scanning, 79, 80Iliotibial band (ITB) syndrome, 275, 277,295–297Image acquisition and processingtransducer, 9, 10transducer selection, 10, 11Inferior cluneal nerve, 110, 111clinical benefits, 117patient selection, 112procedure, 117sonoanatomy, 118ultrasound scan, 116Inferior epigastric artery (IEA), 83, 85, 88 Inferior oblique capitis muscle (IOC), 34, 36 In-plane approach, 24, 49, 67, 80, 90, 115,141, 243, 250, 273, 277, 313 Intercostal nerve block, 61, 69anatomy, 62caveats, 62, 64clincial benefits, 69HIFU, RFA, EtOH, ICNB studies, 70–72patientselectionadvantages, 65complications, 65contraindications, 64, 65indications, 64pneumothorax, 72post-procedure follow-up and issues, 68procedure, 67ultrasound scanning, 65, 67KKnee painarticular branches of knee, 347, 348diagnostic block, 350–352distal iliotibial band bursa injectionpathology, 295procedure, 296, 297ultrasound scan, 295, 296intra-articular injection, 287patient selection, 284procedure, 285, 286ultrasound scanning, 284–286patellar tendon injectionsprocedure, 298, 299ultrasound scan, 297, 298patient selection, 348pes anserinus bursa and peritendon injection procedure, 293, 294ultrasound scan, 292, 293Index360Knee pain (cont.)popliteal cyst/Baker’s cystprimary cysts, 287procedure, 289–291semimembranosus-gastrocnemiusbursa, 287, 288ultrasound scanning, 287–289radiofrequency ablation, 336, 352, 353ultrasound guidance, 283ultrasound scaninferomedial articular branches,349, 350superolateral articular branches, 350superomedial articular branches,348, 349LLateral femoral cutaneous nerve (LFCN),121, 124clinical benefits, 127patient selection, 122, 123procedure, 126, 127ultrasound application, 128ultrasound scanning, 124–126Lesser occipital nerve (LON), 34, 35patient selection, 35procedure, 40sonography, 39Long axis, 15, 17, 21, 24, 36, 48, 67,159–161, 222, 255, 259, 264, 273,277, 284, 292, 294, 297, 330, 349,350Low back paindefinitive diagnosis, 169lumbar medial branches (see Lumbarmedial branches)prevalence rate, 169Lumbar medial branchesanatomy, 169, 170patient selection, 170, 171ultrasound scanningL5 dorsal ramus, 176, 178L5 dorsal ramus block, 179–181lumbar medial branch (L1–4) block,179, 180medial branch L1-4, 176, 178paramedial sagittal articular processview, 171, 173paramedial sagittal oblique view,171, 174paramedial sagittal transverse process view, 171, 172procedure, 179sagittal view, 175, 177transverse interlaminar view, 173, 175transverse spinous process view, 173transverse view, 175Lumbar plexus, 75, 76, 83MMedian nerve neuralgia, 247Meralgia paresthetica (MP), 121, 125, 128 Middle cervical ganglion, 45Migraine, 34, 41Mirror imaging artifact, 20–21Motion (M) mode, 4, 5, 30 Musculoskeletal (MSK) scanningadvantages, 207, 208advantages image quality, 208anatomical landmarks, 208anisotropy, 209applications, 207Doppler effect, 209hyaluronic acid injections, 209hyperechoic images, 208image quality, 207injections setup, 209ozone injections, 209platelet-rich plasma injections, 209sonoelastography, 211three-dimensional ultrasound, 210ultrasound guidance, 207OObturatorinternus(OI) muscle, 100cadaveric study, 103clinical benefits, 103patient selection, 100procedure, 102ultrasound scan, 101Occipital artery, 33–35, 37–39Occipital muscle, 35Occipital neuralgia, 35Osteoarthritis (OA), 335Out-of-plane, 24, 27, 49, 105, 117, 127,179, 195, 202, 209, 224, 242, 243,250, 255, 256, 260, 261, 273, 274,309, 312PPACE, 96Paraspinal muscles, 132Patellar tendinopathy, 296, 297Pelvic musclesobturatorinternus muscle, 100–103obturatorinternusmuscle, 100Index361piriformis muscle, 94–96, 99quadratusfemoris, 104–106Peripheral nerve stimulation, 58, 59 Peritendon/bursa injection, 102–103 Piezoelectric elements, 10Piriformis muscle, 93–96, 98–100clinicalbenefits, 98insciatic neuropathy, 99and neurovascular structures, 95patient selection, 95procedure, 98ultrasound scan, 97Piriformis syndrome, 93–95, 99, 100 Platelet-rich plasma (PRP)anti-inflammatory and pro-inflammatoryeffects, 320clinical application, 321contraindications, 322growth factors, 318, 320mechanisms of effects, 318pattern of healing, 319platelet physiology, 318preparation, 322proteins, 319regulatory landscape, 319, 320research and clinical utilization, 317role of, 318supra-physiologic concentration ofplatelets, 317in tendinopathy treatment, 321on tissue regeneration, 322 Pneumothorax, 64, 65, 68, 72Posterior superior iliac spine (PSIS), 97, 112, 113, 175, 187Power Doppler, 13, 14Pudendal entrapment neuropathy, 109, 110 clinical benefits, 117patient selection, 112procedure, 115sonoanatomy, 118ultrasound scan, 113–115Pudendal nerve, 78, 84, 95, 109–115 Pudendal nerve block, 118Pudendal neuralgia, 109, 112Pulse length (PL), 3, 10Pulse repetition frequency (PRF), 3, 9 Pulsed radiofrequency, 41, 50, 55, 78QQuadratusfemoris (QF), 104fluoroscopy- and CT-guided injections, 106 patient selection, 104procedure, 105ultrasound scan, 105RRadiofrequency ablation (RFA), 70–72, 335,336, 347–349, 353, 354 Reflection, 7–8, 15, 208Reverberation artifact, 18, 19SSacral lateral branch (SLB)anatomy, 186clinical indication, 185patient selection, 186ultrasound scanningprocedure, 188sagittal plane scan, 188Sacroiliac joint (SIJ)anatomy, 185, 191–193clinical indication, 185patient selection, 186, 192radiofrequency ablation, 191, 193,195, 196ultrasound scanning, 192, 194procedure, 188, 189transverse plane scan, 186, 187 Scapular spine, 55, 57, 221Scattering, 5, 7–9Sciatic nerve, 93, 95, 96, 98–100, 102–105,110, 115, 116, 268Sciatic neuropathy, 99Semispinalis capitis muscle (SSC), 34, 36,161, 162, 166Short axis, 17, 24, 48, 58, 151, 161–163, 203, 208, 220, 223, 224, 249, 254, 259,260, 276–277, 289, 296, 298, 307,351Shoulder pain, 53–55, 58, 59, 213–216 lifetime prevalence, 213patient selection, 216, 217, 219shoulder girdle anatomyacromioclavicular joint, 216, 217coracohumeral ligament (CHL), 214GH joint capsule, 214glenohumeral (GH) joint, 214joint capsule, 216long head of biceps (LHB)tendon, 215rotator cuff muscles, 215subacromial impingement, 215subacromial subdeltoid(SASD), 215superior glenohumeral ligament(SGHL), 214ultrasound scanAC joint, 222–224anterior GH joint approach, 225, 226Index362Shoulder pain (cont.)LHB tendon, 224, 225LHB tendon and rotator interval, 219,220posterior glenohumeral joint, 221supraspinatus tendon and SASD bursa, 221, 222Sonoanatomy, 46, 91, 113, 114, 118, 139,237–240, 306–312tissue echogenicity, 15tissue features, 16–18Sonography, 39, 40, 47, 80, 81, 87, 99, 102,103, 116, 153Sound wave, 1Spermatic cord, 83, 87, 90Stellate ganglion block (SGB), 43Superior articular process (SAP), 154,161, 162, 165, 166, 170, 173,175, 179Superior cervical ganglion, 45 Suprascapular nerve (SN), 54anatomy, 53, 54clinical benefits, 58, 59diagnosis, 54diagnostic criteria, 55HSS and CRPS, 59pathophysiology and clinical presentation, 53, 55patient selection, 55procedure, 57, 58ultrasound guided peripheral nervestimulation of, 58ultrasound scanning, 55–57 Suprascapular nerve block (SNB), 55 Sympathetic fibers, 43TThenar atrophy, 248Third occipital nerve (TON)anatomy, 158patient selection, 158ultrasound scanC5, C6 medial branches, 164, 165C7 medial branches, 165coronal scan, 159–161needle placement, 165, 166procedure, 164TON, C3, C4 medial branches, 164transverse scan, 161–163Time motion, 5Transducer, 9, 10, 36handling, 22selection, 10, 11Transmission, 9, 18Transversus abdominis muscle, 75–77, 79–81 UUltrasoundimage acquisition and processingtransducer, 9, 10transducer selection, 10, 11machine operation, 12depth, 12, 13Doppler, 13focus, 13, 14gain, 12machine operation, Doppler, 14scanning and performanceand positioning terminology, 22, 23ergonomics, 23, 25ergonomics, 27, 28transducer handling, 22sonoanatomy and artifactacoustic enhancement artifact, 18acoustic shadowing, 18air artifact, 21anisotropy, 21edge shadowing, 20mirror imaging artifact, 20reverberation artifact, 18tissue echogenicity, 15tissue features, 16, 17sound wave, characteristic of, 1tissue interaction, 5absorption, 6, 7reflection, 7, 8scattering, 8transmission, 9transmission, 9ultrasound image, generation of, 4, 5ultrasound wave, generation of, 2, 3 Ultrasound-guided cervical nerve root block,151–153analgesic efficacy, 155in cadavers, 154clinical benefits, 154efficacy and safety, 155with fluoroscopy, 154fluoroscopy guided injection and, 155 procedure, 152, 154Index。

超声引导下竖脊肌平面阻滞对腹腔镜胆囊切除术后镇痛效果及炎症因子的影响

DOI:10.3969彳.issn.1672-9463.2020.12.005超声引导下竖脊肌平面阻滞对腹腔镜胆囊切除术后镇痛效果及炎症因子的影响段磊史创国王娜奥辉【摘要】目的观察超声引导下竖脊肌平面阻滞(Erector spinae plane block,ESPB)对腹腔镜胆囊切除术(Lapai•_ oscopic cholecystectomy,LC)Jn镇痛效果及炎症因子的影响。

方法本研究为前瞻、双盲、随机对照试验。

纳入择期LC 患者60例,随机分为试验组(E组)和对照组(C组)，各30例。

E组中，于第7胸椎棘突水平实施超声引导下双侧ESPB,每侧给予20ml0.2%罗哌卡因，共40ml;C组给予相同阻滞方法和等体积容量的生理盐水,两组术后行患者自控静脉镇痛(PCIA)。

记录术中瑞芬太尼及术后纳布啡的消耗量;患者术前12h及术后12h血中C反应蛋白(CRP)、肿瘤坏死因子-a(TNF-a)、皮质醇(Cor)浓度;术后启动PCIA泵的时间;术后3、6、9、12、24h视觉模拟评分(Visual analogue scale, VAS),术后24h内PCA按压总次数、有效按压次数及镇痛失败补救次数;术后镇痛不良反应发生率。

结果术中瑞芬太尼及术后纳布啡消耗量比较，E组均显著低于C组(PO.05);术后12h血中CRP、TNF-a及Cor浓度比较，E组均显著低于C ffl(P<0.05);E组术后PCIA泵开启时间晚于C组(PV105);术后3、6、9、12h VAS疼痛评分比较，E组均显著低于C组(P<0.05);术后24h内，E组PCIA按压总次数及有效按压次数均少于C组(P<0.05);E组术后镇痛恶心、呕吐发生率较C组低(P<0.05)。

结论超声引导下ESPB有助于减少LC术中及术后镇痛药物的用量,降低术后疼痛评分和术后镇痛恶心、呕吐发生率并抑制术后炎症反应。

[关键词]超声引导竖脊肌平面阻滞腹腔镜胆囊切除术术后镇痛Effect of ultrasound guided erector spinae plane block on postoperative analgesia and inflammatory factors after laparoscopic cholecystectomy Duan Lei,Shi Chuangguo,Wang N a,etal.Department of A nesthesiology,Xi a n Aerospace General Hospital,Xi a n710100[Abstract]Objective To observe the effect of ultrasound guided erector spinae plane block(ESPB)on postoperative analgesia and inflammatory factors after laparoscopic cholecystectomy(LC).Methods This study was a prospective,double—blind,randomized controlled trial.Sixty patients undergoing elective laparoscopic cholecystectomy were randomly divided into experimental group(group E,n=30)and control group(group C,n=30).In group E, ultrasound guided bilateral ESPB,was given20ml0.2%ropivacaine on each side at the level of the7th thoracic vertebrae.Control group was given normal saline with the same block method and the same volume.Two groups were received PCIA analgesia after surgery.The consumption of remifentanil during operation and nalbuphine for postoperative analgesia were recorded;the concentration of C-reactive protein(GRP),tumor necrosis factor-a(TNF—a), cortisol(Cor)in the blood of patients12hours before and12hours after operation were recorded;the time of starting PCIA pump was recorded,the Visual analogue scale(VAS)at3,6,9,12and24hours after operation, the total times of PCIA compression,the times of effective compression and analgesia failures were recorded.The incidence of adverse reactions of postoperative analgesia were recorded.Results Compared with the control group, the consumption of remifentanil and postoperative analgesia in group E was significantly lower than that in group C (P<0.05).The concentrations of CRP,TNF—a and Cor in group E were significantly lower than those in group C at12hours after operation(P<0.05).The postoperative PCIA pump opening time of group E was later than that in group C(P<0.05).The VAS pain scores at3,6,9and12h after operation in group E were significantly lower than those in group C(P<0.05).The total number and effective number of PCIA compressions in group E were lower than those in group C within24hours after operation(P<0.05).The postoperative analgesia associated nausea and vomiting作者单位：710100陕西西安，西安航天总医院麻醉科rates in group E were lower than those in group C(P<0.05).Conclusion Ultrasound guided ESPB can help reduce the dosage of analgesics used during and after laparoscopic cholecystectomy,reduce the VAS pain scores and the incidence of postoperative analgesia associated nausea and vomiting and inhibit postoperative inflammatory response.[Key words]Ultrasound guidance Erector spinae plane block Laparoscopic cholecystectomy Postoperative analgesiaLC为肝胆外科常见微创手术，LC术后会引发中、重度疼痛，产生炎性介质释放,诱发中枢和外周痛觉敏化，严重影响患者术后正常生理机能的恢复[1]0 LC术后的疼痛主要为内脏痛，临床上常采用阿片类K受体激动剂/|JL受体拮抗剂治疗内脏痛，但由于阿片类药物可能产生镇痛不全及镇痛相关的不良反应，因此亟需一种安全有效的镇痛方式来提高术后镇痛效果,促进患者快速康复。

超声造影延迟相廓清的肝炎性病灶与肝细胞癌的鉴别与分析

·临床研究·作者单位：430030武汉市，华中科技大学同济医学院附属同济医院超声影像科通讯作者：李开艳，Email ：Liky20006@126com超声造影延迟相廓清的肝炎性病灶与肝细胞癌的鉴别与分析黄哲周萍萍吴晓贝李珊珊罗鸿昌李开艳摘要目的探讨超声造影及其定量分析对延迟相廓清的肝炎性病灶与肝细胞癌的鉴别诊断价值。

方法分析经手术或穿刺活检病理证实的38例肝炎性病灶患者（肝炎性病灶组，共38个病灶）和66例肝细胞癌患者（肝细胞癌组，66个病灶）的超声造影检查资料，分析并比较超声造影定量参数鉴别肝炎性病灶与肝细胞癌的截断值及其诊断效能。

结果肝炎性病灶组与肝细胞癌组在患者性别、临床症状、血清糖水平抗原125、甲胎蛋白（AFP ）水平和乙型肝炎病毒感染史等方面比较，差异均有统计学意义（均P <0.05）。

肝炎性病灶组超声造影提示形态不规则和边界不清晰比例（23/38、30/38）均高于肝细胞癌组（10/66、4/66），差异均有统计学意义（均P <0.01）；肝炎性病灶组表现为门脉相低增强30例、等增强8例，肝细胞癌组表现为门脉相低增强26例、等增强34例、高增强6例，两组比较差异有统计学意义（P <0.01）。

定量分析显示，肝炎性病灶组时间-强度曲线的曲线下面积（AUC ）较肝细胞癌组增大，下降时间、平均通行时间均较肝细胞癌组缩短，差异均有统计学意义（均P <0.05）。

单变量分析结果显示，AUC>365.281、平均通行时间<22s 、下降时间<35.5s 鉴别肝炎性病灶与肝细胞癌的敏感性和特异性分别为100%和68.2%、92.4%和73.7%、100%和60.5%；Logistic 回归多变量分析结果显示，AUC>365.281诊断肝炎性病灶为良性病变的符合率为100%。

结论超声造影为表现为延迟相廓清的肝炎性病灶与肝细胞癌的鉴别诊断提供了重要信息，定量分析可客观地显示病灶的血流灌注特征，具有较好的临床应用价值。

超声引导微波消融治疗腹壁子宫内膜异位症

超声引导微波消融治疗腹壁子宫内膜异位症刘玉江，徐瑞芳*，钱林学首都医科大学附属北京友谊医院超声科，北京100050；*通信作者徐瑞芳【摘要】目的探讨超声引导下微波消融（MWA）治疗腹壁子宫内膜异位症（AWE）的安全性和有效性。

资料与方法回顾性收集2014年8月—2023年6月在北京友谊医院接受MWA治疗AWE的患者17例（共19个病灶）。

治疗前后使用常规超声、彩色多普勒超声和静脉超声造影观察病灶变化情况。

记录治疗后3、6、12个月AWE病灶体积、体积缩小率、疼痛缓解及并发症情况，评估治疗效果。

结果超声造影显示所有病灶均一次完全消融成功。

病灶平均初始体积为（7.46±5.82）ml，术后3、6、12个月随访时体积分别缩小至（4.32±2.76）ml、（2.47±1.68）ml、（1.72±1.16）ml（t=0.423，P=0.005；t=0.198，P=0.001；t=0.556，P=0.002），平均体积缩小率分别为（46.18±24.36）%、（61.43±18.72）%、（74.25±13.26）%。

所有患者治疗12个月后腹壁周期性切口疼痛明显减轻或消失。

1例患者术后出现局部皮肤灼伤，其余患者未出现严重并发症。

结论MWA治疗AWE 安全有效，值得进一步研究。

【关键词】子宫内膜异位症；微波；消融技术；超声检查【中图分类号】R445.1；R711.71 【DOI】10.3969/j.issn.1005-5185.2024.03.014Ultrasound-Guided Microwave Ablation for the Treatment of Abdominal Wall Endometriosis LIU Yujiang, XU Ruifang*, QIAN LinxueDepartment of Ultrasound, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing 100050, China; *Address【Abstract】Purpose To investigate the safety and effectiveness of ultrasound-guided microwave ablation (MWA) in the treatment of abdominal wall endometriosis (AWE). Materials and Methods A total of 17 patients (19 lesions) with AWE who underwent MWA in Beijing Friendship Hospital from August 2014 to June 2023 were retrospectively analyzed. Grey-scale and color Doppler flow ultrasonography, and contrast-enhanced ultrasonography were used to observe the lesions before and after treatment. The AWE lesion volume, volume reduction rate, pain relief, and complications were recorded 3, 6, and 12 months after treatment to evaluate the treatment efficacy. Results Contrast-enhanced ultrasound showed that all lesions underwent successful treatment with single MWA. The average initial nodule volume was (7.46±5.82) ml, which decreased significantly to (4.32±2.76) ml, (2.47±1.68) ml, (1.72±1.16) ml at 3, 6 and 12 months follow-up (t=0.423, P=0.005; t=0.198, P=0.001; t=0.556, P=0.002) with a mean volume reduction rate of (46.18±24.36)%, (61.43±18.72)%, (74.25±13.26)%, respectively. Notably, all 17 patients experienced a significant decrease or complete alleviation of periodic abdominal incision pain at 12-month after treatment. One patient experienced local skin burns after the procedure, while the remaining patients did not experience severe complications. Conclusion MWA is safe and effective for treating AWE, and further research is warranted.【Key words】Endometriosis; Microwave; Ablation techniques; UltrasonographyChinese Journal of Medical Imaging, 2024, 32 (3): 279-283腹壁子宫内膜异位症（abdominal wall endometriosis，AWE）是子宫内膜腺体和间质出现于腹壁的一种最常见的盆腔外子宫内膜异位症[1-2]。

氨茶碱两种不同用药方法应用于毛细支气管炎治疗的效果研究

0　引言毛细支气管炎，简称为支气管炎，属于儿科呼吸系统疾病，常见于2岁以下的小儿。

氨茶碱，是一种茶碱与乙二胺复盐，在控制支气管哮喘症状方面，效果显著，以往，静脉滴注为常用的给药方式，其疗效个体化差异较大，且易出现不良反应。

近几年，氨茶碱雾化吸入给药方式逐渐得到应用[1]。

为探究氨茶碱两种不同用药方法应用于毛细支气管炎治疗的效果，本院以120例毛细支气管炎患者为对象，分别给予氨茶碱静脉滴注治疗和氨茶碱雾化吸入治疗，取得了一定成效，现将相关报道如下：1　资料与方法1﹒1　一般资料选取2014年9月至2015年12月期间本院收治的120例毛细支气管炎患者，采用随机分组方式，将其分为研究组与对照组，各60例。

对照组，包括34例男和26例女，3-24个月为年龄区间，（7.3±1.29）个月为平均年龄。

研究组，包括31例男和29例女，5~24个月为年龄区间，（6.8±1.02）个月为平均年龄。

所有患者均符合毛细支气管炎诊断标准，且两组患者在性别、年龄等方面差异无统计学意义，具有可比性（P >0.05）。

1﹒2　方法待患者入院后，给予常规对症治疗，主要包括吸氧、抗感染、镇静、止咳化痰等。

（1）对照组：在常规治疗基础上，给予氨茶碱两种不同用药方法应用于毛细支气管炎治疗的效果研究樊冬青（河北省保定市阜平县中医院内科，河北保定）摘要：目的：探究氨茶碱两种不同用药方法应用于毛细支气管炎治疗的效果。

方法：选取2014年9月至2015年12月期间本院收治的120例毛细支气管炎患者，采用随机分组方式，将其分为研究组与对照组，各60例。

对照组，给予氨茶碱静脉滴注治疗，研究组，给予氨茶碱雾化吸入治疗，对比两组患者治疗效果和不良反应。

结果：研究组治疗总有效率为95%，对照组治疗总有效率为93﹒4%，差异不显著，无统计学意义（P >0﹒05）。

研究组不良反应率为3﹒3%，对照组为11﹒6%，研究组明显低于对照组，差异具有统计学意义（P <0﹒05）。

英语角

沿着已知的神经行走方向滑动超声探头，短轴切面经常是看见神经从的形成图像的最好方式。
4.Successful local anesthetic injections clarify the border of the nerve and track along the nerve path and its branches.
超声也可以提供针尖位置和药物注射情况的实时图像。
3.Sliding the ultrasound transducer along the known course of a nerve with it viewed in short axis is often the best way of visualizing fascicles to confirm nerve identity. visualize [ˈvɪʒuəˌlaɪz] vt. 形成思维图像；设想；使可见； fascicle[ˈfæsɪkəl] n. 肌束；（花、叶等的）束；簇；丛
potential[pəˈtɛnʃəl] adj. 潜在的，有可能的n. 潜力，潜能；
在神经位置的解剖变异是阻滞失败的潜在原因，这是可以（在超声上）直接看见的。
6.Ultrasound imaging can prevent and
detect critical events such as intravascular or intraneural injection, which may improve safety during regional anesthesia procedures. intravascular[ˌɪntrəˈvæskjəlɚ] adj. 血管内的； intraneural[ ɪntræn'jʊərəl ]adj. 神经内的

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Submit a Manuscript: https:// World J Clin Cases 2019 May 26; 7(10): 1161-1168 DOI: 10.12998/wjcc.v7.i10.1161ISSN 2307-8960 (online)CASE REPORT Ultrasound guidance for transforaminal percutaneous endoscopic lumbar discectomy may prevent radiation exposure: A case reportMing-Bo Zhang, Long-Tao Yan, Shou-Peng Li, Ying-Ying Li, Peng HuangORCID number: Mingbo Zhang (0000-0002-7990-3493); Longtao Yan (0000-0002-4518-7396); Shoupeng Li (0000-0002-5675-0068); Yingying Li (0000-0003-4757-9550); Peng Huang (0000-0001-6221-0861).Author contributions: Zhang MB and Yan LT contributed equally to this work and should be considered co-first authors; Zhang MB and Yan LT reviewed the literature, performed the ultrasound-assisted transforaminal percutaneous endoscopic lumbar discectomy, and contributed to manuscript drafting; Li SP and Li YY reviewed the literature and contributed to data collection; Huang P was responsible for establishment of ultrasound guidance method and the revision of the manuscript; all authors issued final approval for the version to be submitted. Supported by Clinical Research Support Fund of PLA General Hospital, No. 2018XXFC-18. Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.Conflict-of-interest statement: The authors declare that they have no conflict of interest.CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).Open-Access: This article is an Ming-Bo Zhang, Shou-Peng Li, Ying-Ying Li, Department of Ultrasound, General Hospital of Chinese PLA, Beijing 100853, ChinaLong-Tao Yan, Department of Pain, China-Japan Friendship Hospital, Beijing 100029, China Peng Huang, Department of Orthopedics, General Hospital of Chinese PLA, Beijing 100853, ChinaCorresponding author: Peng Huang, MD, Associate Professor, Department of Orthopedics, General Hospital of Chinese PLA, No. 28, Fuxing Road, Haidian District, Beijing 100853, China. harryhp@Telephone: +86-10-66875503AbstractBACKGROUNDPercutaneous endoscopic lumbar discectomy (PELD) has become a mature and mainstream minimally invasive surgical technique for treating lumbar disc herniation (LDH). Repeated ﬂuoroscopy, with more than 30 shots on average, is inevitable to ensure its accuracy and safety. However, exposure to X-rays may pose a threat to human health. We herein report a case of ultrasound (US)-assisted PELD in two levels of LDH to explore a new possibility that can reduce the radiation dose during puncture and cannulation in PELD.CASE SUMMARYA 38-year-old man with low back pain and left leg pain for more than 7 years came to our clinic, his symptoms had aggravated for 1 month, and he was diagnosed with L3-4 and L4-5 disc herniations. He received US-guided PELD with good results: His straight leg elevation increased from 40 to 90 degrees after PELD, and his visual analog scale (VAS) and Oswestry Disability Index scores both significantly decreased immediately and 6 mo after PELD. With the guidance of US, he received only two shots of fluoroscopy (fluoroscopic time: 4.4 s; radiation dose: 3.98 mGy). To our knowledge, this is the first case of US-guided puncture and cannulation of PELD for LDH at two levels.CONCLUSIONUS could be used to guide PELD and has the potential to largely reduce radiation than traditional X-ray guidance.Key words: Ultrasound; Endoscopic lumbar discectomy; Lumbar disc herniation; Radiation; Guidance; Case reportopen-access article which wasselected by an in-house editor andfully peer-reviewed by externalreviewers. It is distributed inaccordance with the CreativeCommons Attribution NonCommercial (CC BY-NC 4.0)license, which permits others todistribute, remix, adapt, buildupon this work non-commercially,and license their derivative workson different terms, provided theoriginal work is properly cited andthe use is non-commercial. See:/licenses/by-nc/4.0/Manuscript source : Unsolicitedmanuscript Received: January 13, 2019Peer-review started: January 14,2019First decision: January 30, 2019Revised: March 1, 2019Accepted: March 16, 2019Article in press: March 16, 2019Published online: May 26, 2019P-Reviewer: Bazeed MF, Cui XW,Gao BL, Valek VS-Editor: Ji FFL-Editor: Wang TQE-Editor: Wu YXJ ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.Core tip: Percutaneous endoscopic lumbar discectomy, a mature and mainstream minimally invasive surgical technique for treating lumbar disc herniation (LDH), needs more than 30 shots of ﬂuoroscopy each level on average, causing a threat to human health. With the help of ultrasound (US) guidance, we report a patient with two levels of LDH who received only two shots to achieve satisfactory results. US guidance has great potential to become an alternative method to reduce radiation largely.Citation: Zhang MB, Yan LT, Li SP, Li YY, Huang P. Ultrasound guidance for transforaminal percutaneous endoscopic lumbar discectomy may prevent radiation exposure: A case report.World J Clin Cases 2019; 7(10): 1161-1168URL : https:///2307-8960/full/v7/i10/1161.htm DOI : https:///10.12998/wjcc.v7.i10.1161INTRODUCTION Transforaminal percutaneous endoscopic lumbar discectomy (PELD) has become a mature and mainstream minimally invasive surgical technique for treating lumbar disc herniation (LDH)[1-4]. Fluoroscopy, to ensure the accuracy of puncture and cannulation, is inevitable. However, radiation exposure with X-ray guidance of PELD may be of concern because of its deleterious effects for both patients and surgeons.Therefore, an image guiding system without X-ray is needed to perform PELD.Ultrasound (US) is a real-time dynamic imaging facility with no ionizing radiation.We herein report a case of US-assisted PELD on a 38-year-old man with two levels ofLDH at the same time. Our successful experience may contribute to the application of US-guided PELD in the future.CASE PRESENTATIONA 38-year-old man [height: 174 cm; weight: 74.5 kg; body mass index (BMI): 24.6kg/m 2] with low back pain and left leg pain for more than 7 years and aggravatedsymptoms for 1 mo came to our hospital.History of present and past illnessHis previous history and family history were negative. He had lameness on his leftleg.Physical examinationPhysical examination showed tenderness and percussion pain radiation to the left legfrom the left part of the L4-S1 vertebral spinous processes. Dermal sensation in his leftlateral leg and left foot was decreased. Left straight leg raising and strengthening testhad positive results (40 degrees).Imaging examinationsX-ray showed small curvature of the lumbar spine. Computed tomography (CT) andmagnetic resonance imaging (MRI) showed L3-4 and L4-5 disc herniations (leftmargin type) (Figure 1).FINAL DIAGNOSIS The patient was diagnosed with LDH of the L3-4 and L4-5 levels (left margin type).TREATMENTThe patient needed PELD of both L3-4 and L4-5 levels. Institutional approval forPELD was obtained from the ethics committee of our hospital, and the procedure inthis study was performed in accordance with the tenets of the Declaration of Helsinki.Zhang MB et al. Ultrasound-assisted endoscopic lumbar discectomyFigure 1 X-ray and computed tomography transverse images of the patient. A and B: X-ray images showingsmall curvature of the lumbar spine; C: Computed tomography (CT) image suggesting L3-4 disc herniation (blackarrow, left margin type); D: CT image suggesting L4-5 disc herniation (black arrow, left margin type).Written informed consent was obtained from the patient. A portable Mindray M9 USsystem (Mindray, Shenzhen, China) with a C5-1S convex array transducer (centralfrequency: 5 MHz) was used in this study. The patient laid in a prone position on aradiolucent table with a pillow under his belly. One US physician with more than 4years of experience in interventional US performed the US guidance. First, alongitudinal section was used to display the transverse processes, and the lowesttransverse process was L5. Second, the probe was rotated by 90 degrees to display theL5 transverse process. The probe was moved upward, and the soft tissue in theintervertebral foramen of L4-5 appeared as a circular hyperechoic zone (HZ), whichwas located below the facet joint (Figure 2). The auxiliary line on the patient’s backskin was drawn at least 9-13 cm away from the midline. Third, the probe was movedto the next highest level to locate the L3-4 intervertebral disc using the same method.One spinal surgeon with more than 5 years of experience in PELD performed thepuncture and cannulation under the guidance of US (Figure 3). The HZ, which waslocated below the facet joint, was used as the target, and the needle was inserted fromthe 12 o’clock position to the 3 o’clock position of the HZ. The tip of the 18-gaugespinal needle first touched the facet joint and then slipped into the intervertebralforamen. G-arm X-ray (Whale, Massachusetts, United States) in the anteroposteriorand lateral views was used to confirm that the needle tip arrived at the target point. Aspecial instrument set (transforaminal endoscopic surgical system; joimax ® GmbH,102 Karlsruhe, Germany) was applied in the procedure. The guidewire was insertedthrough the spinal needle, which was removed thereafter. Then, the obturator andreamer were introduced along the guidewire. Finally, the expanders and outer sheathof the endoscope were inserted through the guidewire one after another (Figure 4).The US-guided puncture lasted 4.5 min (2 min for L3-4 and 2.5 min for L4-5), andthe US-guided cannulation lasted 5.5 min (2.5 min for L3-4 and 3 min for L4-5). Thepositions of the puncture needles and working sheaths were accurate, which wastested by two shots of G-arm fluoroscopy, with a total fluoroscopic time of 4.4 s and atotal radiation dose of 3.98 mGy. Partial hypertrophied facetectomy was performedusing a 3.0-mm endoscopic lateral bur (drill diameter: 3.0 mm, XISHAN, China)(Figure 5). Then, transforaminal PELD was performed as previously described byWen et al [5].OUTCOME AND FOLLOW-UPZhang MB et al. Ultrasound-assisted endoscopic lumbar discectomyFigure 2 Transverse ultrasound image of the lumbar spine. SP: Spinous process; FJ: Facet joint; HZ:Hyperechoic area.The operation decompression lasted 82 minutes for two levels (Figure 5B -D), and itwas completed with no complications. The patient's straight leg elevation increasedfrom 40 to 90 degrees after PELD (Figure 6). Immediately following PELD, the visualanalog scale (VAS) score of his low back pain decreased from 6 to 1, his leg pain scoredecreased from 8 to 1, and his Oswestry Disability Index (ODI) score decreased from73 to 11. Videos of the patient’s gait immediately after surgery showed a normal andsymmetric appearance of the two legs, and the spinal MRI after PELD showedcomplete decompression of the two levels (Figure 7). The patient was taught a set ofwaist exercises after the operation to reduce the recurrence of disc herniation afterPELD. Follow-up at 6 months after PLED showed that the treatment effect remainedthe same without recurrence, with the patient showing 90 degrees of straight legelevation, a VAS of 1 for both low back pain and leg pain, and an ODI of 10. The pati-ent was very satisfied with the treatment, especially with the reduction of radiation.DISCUSSIONRepeated ﬂuoroscopic scanning is essential for the puncture and cannulation duringPELD. Fan et al [6] showed that 34.32±4.78 fluoroscopy shots were needed inconventional PELD. They showed that this number was 33.98 ± 2.69 in another groupof patients [7]. Patients with more difficult positioning and more treatment levels mayreceive larger radiation dose, and the same effect will occur in inexperiencedsurgeons. Fluoroscopic scanning may increase the incidence of malignant tumors,such as thyroid cancer, skin erythema, leukemia and so on [8]. For pregnant women,exposure to X-ray radiation may increase the risk for fetal malformations ordevelopmental abnormalities. High cumulative effective doses also have been foundin patients with Crohn’s disease [9], cystic ﬁbrosis [10], and end-stage kidney disease [11].With the guidance of US, the patient in this study received only two shots offluoroscopy with a low radiation dose of only 3.98 mGy. Future studies with largersamples are needed to validate this technique as an alternative to fluoroscopy.US has been reported to display intervertebral disc degeneration [12,13] and focalstenosis [14]. It has been used in the guidance of facet joint injections [15], selective nerveroot blocks [16], lumbar transforaminal injections [17] and so on. However, due toocclusion of the lumbar spine, displaying the intervertebral foramen remainschallenging. Recently, real-time US-MRI or US-CT fusion image virtual navigation hasbeen demonstrated to be an effective and precise method for guiding PELD [18,19] orlocating an intraspinal tumor [20]. However, the navigation process performed duringthese procedures is complicated and requires a special navigation system, such aselectromagnetic tracking system, which is not easily available.Few studies have focused on US-guided PELD. Wu et al [21] reported an initial studyof US-assisted PELD and suggested that US-guided PELD can be successfullyperformed for patients with a BMI less than 24. In this study, we successfullyperformed US-guided PELD for disc herniation at two levels in a patient with a BMIof 24.6, which suggests that BMI is not always a problem for US guidance. The USguidance method used in our study is different from that used in the above research.They used the facet joint as target and we used the circular HZ above the transverseprocess, which is located below the facet joint, as the target. Furthermore, the needlewas inserted from the 12 o’clock position to 3 o’clock position of the HZ in our study,and no longitudinal scanning was required in our method. The success of the studyZhang MB et al. Ultrasound-assisted endoscopic lumbar discectomyFigure 3 Puncture process of the two spinal needles. A: Ultrasound (US)-guided insertion of the two needles; B: Guidewires were then inserted through the two needles; C: US image of one needle (black arrow indicates the tip of the needle; white arrow indicates the track of the needle); D: Position of the needles in the anteroposterior X-ray image; E: Position of the needles in the lateral X-ray image.proves that, although US cannot penetrate bone, soft tissue or bone markers on UScan be used as guides to assist the puncture.US guidance can not only reduce the radiation dose but also provide real-timedynamic guidance of the needle tip. It can reduce the risk for damage to abdominaland retroperitoneal organs, especially in high level disc herniation. The sheathposition can also be monitored during cannulation, advising the surgeon when to beforceful and when to be careful.Disc herniation of two levels requires double puncture time, longer surgical time,and higher radiation dose administered to the patient. However, with the guidance ofUS, punctures at two levels can be performed at the same time with only two shots offluoroscopy (fluoroscopic time of 4.4 s and radiation dose of 3.98 mGy). The operationdecompression time in our study lasted only 82 min, which is much more likely to beaccepted by patients. The success of this case provides a potential for application ofthis technology. The inclusive and exclusive criteria are meaningful in the process.The inclusion criteria could be radicular leg pain caused by soft LDH with invalidconservative treatment. The exclusion criteria, except for the inherent contrain-dications of PELD, may include obese patients or patients with hyperechoic fasciamuscularis, muscular atrophy, or calcification, since the high attenuation of US makes the anatomical landmarks surrounding the lumbar vertebrae visually unclear.CONCLUSIONThis study is a useful initial attempt and proves that US can be used in the guidanceof the puncture and cannulation of PELD, and can largely reduce the radiation dose.The wide popularization of this technique still needs large samples and controlledstudy. However, with more orthopedists and US physicians mastering spine US andwith the additional development of more practical tools, such as punctured guiding stents, this technology will become more mature and thus has great potential.Zhang MB et al. Ultrasound-assisted endoscopic lumbar discectomyFigure 4 Cannulation process of the two endoscope outer sheaths. A: The endoscope outer sheaths were inserted through the guidance wire; B: Ultrasound (US) image of one sheath (white arrow indicates the track of the sheath; the tip of the sheath was hidden in the US shadow and could not be displayed); C: Position of the sheaths in the anteroposterior X-ray image; D: Position of the sheaths in the lateral X-ray image.Figure 5 Percutaneous endoscopic lumbar discectomy for lumbar disc herniation at two levels. A: Partial hypertrophied facetectomy was performed using a 3.0-mm endoscopic lateral bur; B: Percutaneous endoscopic lumbar discectomy was performed for lumbar disc herniation at two levels at the same time; C: Direct visualization of the blue dye in the protruding intervertebral disc through the endoscope; D: The protruding intervertebral disc was removed to decompress the spinal nerve.Zhang MB et al. Ultrasound-assisted endoscopic lumbar discectomyZhang MB et al. Ultrasound-assisted endoscopic lumbar discectomyendoscopic lumbar discectomy (PELD); B: Straight leg elevation increased to 90 degrees after PELD.Figure 7 Lumbar spine magnetic resonance imaging before and after percutaneous endoscopic lumbar discectomy. A: Transverse section suggesting L3-4 disc herniation (white arrow, left margin type); B: Same section 1 day after percutaneous endoscopic lumbar discectomy (PELD) (black arrow indicates disappearance of the herniation); C: Transverse section suggesting L4-5 disc herniation (white arrow, left margin type); D: Same section 1 day after PELD (black arrow indicates disappearance of the herniation); E: Sagittal section suggesting L3-4 and L4-5 disc herniations (white arrows); F: Same section 1 d after PELD (black arrows indicate disappearance of the herniations).REFERENCES1Cong L, Zhu Y, Tu G. A meta-analysis of endoscopic discectomy versus open discectomy forsymptomatic lumbar disk herniation. 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