Gaisma palīdz simpātisko bloku vizualizācija.
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1 Gaisma palīdz simpātisko bloku vizualizācija. A. Miščuks M. Arons Dr.med. I. Golubovska Dr. phys. U. Rubīns ESF projekts 2009/0211/1DP/ /09/APIA/VIAA/077
2 Darba mērķi: Mūsu darba galvenais mērķis bija izveidot jaunu, vienkāršu, neinvazīvu, bezkontakta optisko metodi simpātiskās blokādes apstiprināšanai, invazīvi ārstējot hroniskās neiropātiskās sāpes. Darba uzdevums: apstiprināt korektu adatas un injekcijas lokalizāciju, veicot lumbālo simpātisko blokādi un neirolīzi, ne tikai izmantojot Rtgkontrasta izmeklējumu, bet arī objektīvas izmeklēšanas metodes (PPGI).
3 Materiāli un metodes: Pētījumam tika atlasīti pacienti, kuriem hronisku neiropātisku sāpju gadījumā varētu būt lietderīgi veikt vienpusēju lumbālo simpātisko blokādi ar sekojošu neirolīzi. Simpātiska blokāde tika veikta L3 līmenī Rtg kontrolē AP un RR skatā. Pēc adatas pozīcijas verifikācijas ar kontrastu tika ievadīts 100 mg/8 ml Lidokaīna. Gaisma tika izmantota asinsvadu pulsācijas amplitūdas noteikšanai ādas apakšējos slāņos. Amplitūdas izmaiņās tika analizētas tiešsaistes režīmā. Jā PPGI amplitūda pieauga vismaz 2 reizes, simpātisko bloku uzskatīja par izdevušos un ievadīja neirolītisko medikamentu fenolu.
4 Lumbāras simpātiskās blokādes Indikācijas Cirkulatoras Inoperable perifēras vaskulāras slimības un vazospastiskie stāvokli apakšejās ekstremitātēs Sāpes Neuropātiskas sāpes Refleks- simpāto- distrofijas Urogēniskas/Pelvic sāpes Cancer sāpes Phantom sāpes Herpes Zoster sāpes apakšejā ekstremitatē
5 Lumbāras simpātiskās blokādes
6 Lumbāras simpātiskās blokādes
7 Quantitative methods Simpātiskā bloka verifikācija Thermogrāfija Thermomētrija Uniform Distribution of Skin-Temperature Increase After Different Regional-Anesthesia Techniques of the Lower Extremity. R.Werdehausen, S.Braun, H.Hermanns, R.Freynhagen, P.Lipfert, M. Stevens Regional Anesthesia and Pain Medicine, Skin temperature after interscalene brachial plexus blockade. Hermanns H, Braun S, Werdehausen R, Werner A, Lipfert P.Stevens MF. Reg Anesth Pain Med 2007;32: NWAC, Dubaji Thermographic temperature measurement compared with pinprick and cold sensation in predicting the effectiveness of regional blocks. Galvin EM, Niehof S, Medina HJ, et al. Anesth Analg Modification and optimisation of monitoring for regional anaesthesia. A. Miščuks,R. Erts,U. Rubīns, prof.j. Spīgulis, prof.m. Mihelsons Affiliations of authors:¹university of Latvia, ²Institute of Atomic physics and spectroscopy, ³The Faculty of Medicine; 2010, NWAC,Dubaj
8 Quantitative methods Simpātiskā bloka verifikācija Functionālā MRI
9 Quantitative methods Simpātiskā bloka verifikācija Elektrodermāla aktivitāte. (EDAelectrodermal activity). Ādas konduktivitāte kontrole. The assessment of postoperative pain by monitoring conductance: results of a prospective study* T. Ledowski, J. Bromilow, J. Wu,M. J. Paech, H. Storm and S. A. Schug; Anaesthesia, 2007, 62, pages
10 Quantitative methods Simpātiskā bloka verifikācija Pulsoksimētrija Peripheral flow index Pulse oximeter perfusion index as an early indicator of sympathectomy after epidural anesthesia. Ginosar Y, Weiniger CF, Meroz Y, Kurz V, Bdolah-Abram T, Babchenko A, Nitzan M, Davidson EM. Acta Anaesthesiol Scand Sep;53(8): Peripheral flow index is a reliable and early indicator of regional block success. E.M. Galvin, S.Niehof, S.J.Verbrugge, I.Maissan, A.Jahn, J.Klein, and J. van Bommel Anesth. Analg., July 1, 2006; 103(1):
11 Bezkontakta Vizualizācijas fotopletizmogrāfija (PPGI) Lamp HD video light Skin Blood vessels
12 Absorbcijas un Refleksijas PPG Remisijas variantā, iegūtais signāls ir galvenokārt ādas augšējo slāņu vaskulatūras modulēts. Bet absorbcijas variantā, būtiska nozīme ir visa starp gaismas avotu un fotodetektoru esošā audu tilpuma mikrocirkulācijai. Uzskata, ka transmisijas fotopletizmogrammas ir galvenokārt audu absorbētspējas izmaiņu rezultāts. Bet remisija ir vairāk atkarīga no eritrocītu orientācijas un asinsvadu sieniņu kustībām.
13 Bezkontakta optiskā fotopletizmogrāfija (PPGI)
14 Korelācijas starp temperatūras pārmaiņam un PPG amplitūdu (vidēji) Results show statistically significant correlation between temperature and amplitude of PPGI signal (statistical values r=0.96, p<0.0001)
15 Iepriekšejo pētijumu rezultāti PPGI pārmaiņas dinamikā veiksmīgo simpātisko bloku gadījumos PPGI pārmaiņas dinamikā neveiksmīgo simpātisko bloku gadījumos
16 Iepriekšejo pētijumu rezultāti
17 Iepriekšejo pētijumu rezultāti
18 Bezkontakta optiskā fotopletizmogrāfija (PPGI)
19 Simpātiskā bloka verifikācija neizdevās
20 Simpātiskā bloka verifikācija neizdevās
21 Simpātiskā bloka verifikācija izdevās
22 PPGI dinamikā Simpātiskā bloka verifikācija neizdevās - Simpātiskā bloka verifikācija neizdevās - Simpātiskā bloka verifikācija izdevās +
23 Rezultāti: Simpātiskā bloka verifikācija neizdevās ja mērījuma vieta atradās ārpus kājas pēdas reģiona vai netika verificēta pareizā struktūra ( piemēram, kontrasts izplatījās m. ileopsoas vai nervu saknītes rajonā). Uzskatījām, ka simpātiska bloka esamība apstiprināma gadījumā ja PPG amplitūda ir pieaugusi vairāk par +/- standarta deviācijas robežu vienas minūtes intervālā. Eksperimentāla veida konstatēts, ka optimālas PPG signāla pārmaiņas pēc LA ievades konstatējamas uz atbilstošas pēdas.
24 Secinājumi. PPGI ir jauna, neinvazīva, vienkārša metode, kas varētu būt noderīga simpātisko bloku verifikācijai.
25 Izmantota literatūra un vēres /OxiMaxPulseOximetry/Sensors/OxiMaxSensorOverview/t abid/94/default.aspx nation_monitor_m650/ Endopat
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