蛛网膜下腔阻滞课件知识资料PPT-.pptx

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,Page,Page,Page,Page,蛛网膜下腔阻滞,你该知道的,N,件事,目录,1.Concept,2.Procedure,3.Indication/Contraindication,4.Complications,目录,1.Concept,2.Procedure,3.Indication/Contraindication,4.Complications,Concept,蛛网膜下腔,截断性阻滞,History,Bier,把小剂量的可卡因注射到脊髓周围的,脑脊液中。在动物和人身上都取得了,成功。,Trendy Design in contemporary colors and styles-PowerPoint Templates,&Backgrounds,PowerPoint Diagrams&Charts for your Presentation,Doctors sometimes turn out to be their own best guinea pigs,Anne Fawcett.,目录,1.Concept,2.Procedure,3.Indication/Contraindication,4.Complications,注药,消毒铺巾,摆体位,定位,穿刺,调节平面,蛛网膜下腔阻滞流程图,L,3,侧卧位 坐位,目录,1.Concept,2.Procedure,3.Indication/Contraindication,4.Complications,Indication,下腹，盆腔,下肢,肛门会阴部,2-3,小时内,休克,过敏,中枢神经系统疾病,脑脊膜炎、脊髓炎、颅压升高,凝血功能障碍,穿刺部位炎症或感染,败血症,脊椎外伤、结核,精神病,/,严重神经官能症,/,小儿,不能合作的病人,Contraindication,目录,1.Concept,2.Procedure,3.Indication/Contraindication,4.Complications,Complication,Puncture,related,Drug,injection,Postoperative,Infection,Infection,Hematoma,Nerve Root,Spinal,Bleed,Puncture,Related,Meningitis,Arachnoiditis,Abscess,1.,Back or vertebral pain,2.,Nerve root pain,3.,Motor/sensory deficits,or sphincter dysfunction.,4.,Paraplegia or paralysis.,Blood culture,CT,MRI,Antibiotics,Spinal cord,Infection,Hematoma,Nerve Root,Spinal,Bleed,Puncture,Related,Nerve root,Infection,Nerve Root,Hematoma,Spinal,Bleed,Prevention,Observation,Puncture,Related,Bleed,Infection,Hematoma,Nerve Root,Spinal,Bleed,1.,Venous plexus,2.,Pregnancy/AVM,3.,Subarachnoid hemorrhage,Puncture,Related,Hematoma,Infection,Hematoma,Nerve Root,Spinal,Bleed,1.,Spinal,1:220,000,2.,Epidural,1:150,000,3.,Abnormal coagulation,Puncture,Related,Drug,Injection,心血管效应,2,呼吸抑制,3,马尾综合征,4,恶心呕吐,1,Drug,Injection,Cardiac arrest,Low BP,Phrenic nerve,Respiratory,depression,Drug,Injection,Postoperative,Postdural Puncture Headache(PDPH),Transient neurologic symptoms(TNS),Urinary Retention,Backache,Postdural,Puncture Headache,(PDPH),Treatment,1.Oral Analgesics,2.Bed rest,3.Hydration,4.Caffeine infusion,5.Epidural blood patch,1.Frontal/Occipital,2.Tinnitus/Diplopia,3.Upright position,Backache,1.Benign,mild and self-limited,2.Tylenol,ASA,NSAIDs,warm or cold packs,Clinical sign of a more serious complication?,1.Block of S2-S4 root,2.,Opioids,Urinary Retention,Treatment,Catheterization,Transient neurologic symptoms,(TNS),1.Back pain,2.Radiating to the legs,3.Without sensory or motor deficits,4.After the resolution of the block,Resolves spontaneously within several days,Case,L2-3,进针，进针约,6cm,有明显落空感，阻力消失，判断进入硬膜外间隙,继续进针，诉左大腿有过电感持续不缓解,退出穿刺针，重新进行穿刺，过程顺利,术后,4,小时，诉左大腿外侧疼痛伴痉挛性抽搐，左足底轻触即有触电样感觉,女性,，,27,岁,拟在,腰麻,下行,剖宫产,手术,Case,激素,B,族维生素,针灸、理疗,脊神经损伤,术后,2,周：左下肢疼痛及痉挛性抽搐消失，左足底触觉敏感明显减退,Progress,现代麻醉学 第,3,版 人民卫生出版社,临床麻醉学 第,4,版,人民卫生出版社,Anesthesia Miller RD,Handbook of Anesthesiology,Mark R.Ezekiel,MD,MS,References,Thank you!,