蛛网膜下腔阻滞你该知道的N件事情-病例分析模板课件.ppt

1、Page 2目录1.Concept2.Procedure3.Indication/ContraindicationPage 3目录1.Concept2.Procedure3.Indication/ContraindicationConcept蛛网膜下腔截断性阻滞5History1898 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

2、PresentationDoctors sometimes turn out to be their own best guinea pigsAnne Fawcett.Page 6目录1.Concept2.Procedure3.Indication/Contraindication注药消毒铺巾摆体位定位穿刺调节平面L3 侧卧位 坐位 Page 8目录1.Concept2.Procedure3.Indication/ContraindicationIndication下腹，盆腔下肢肛门会阴部 2-3小时内10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

3、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ContraindicationPage 11目录1.Concept2.Procedure3.Indication/ContraindicationPage 12Puncture relatedDrug injectionPostoperativePage 13HematomaSpinalPuncture RelatedMeningitis ArachnoiditisAbscess1.Back or vertebral pain2.Nerve root pain3.Motor/sensory deficits or sphincter d

4、ysfunction.4.Paraplegia or paralysis.Blood culture,CT,MRIAntibioticsPage 14HematomaSpinalPuncture RelatedPage 15Nerve RootSpinalPreventionObservationPuncture RelatedPage 16HematomaSpinal1.Venous plexus2.Pregnancy/AVM3.Subarachnoid hemorrhage Puncture RelatedPage 17HematomaSpinal1.Spinal 1:220,0002.E

5、pidural 1:150,0003.Abnormal coagulationPuncture RelatedPage 18Drug Injection心血管效应2呼吸抑制3马尾综合征4恶心呕吐1Page 19Drug InjectionCardiac arrestLow BPPage 20Phrenic nerveRespiratory depressionDrug InjectionPage 21PostoperativePostdural Puncture Headache(PDPH)Transient neurologic symptoms(TNS)Urinary RetentionB

6、ackachePage 22Postdural Puncture Headache(PDPH)Treatment 1.Oral Analgesics 2.Bed rest 3.Hydration 4.Caffeine infusion 5.Epidural blood patch 1.Frontal/Occipital2.Tinnitus/Diplopia3.Upright positionPage 23Backache1.Benign,mild and self-limited2.Tylenol,ASA,NSAIDs,warm or cold packsPage 241.Block of S

7、2-S4 root 2.Opioids Urinary RetentionTreatmentCatheterization Page 25Transient neurologic symptoms(TNS)1.Back pain2.Radiating to the legs3.Without sensory or motor deficits 4.After the resolution of the block Resolves spontaneously within several daysPage 26Case L2-3进针，进针约进针，进针约6cm有明显落空感，阻有明显落空感，阻力消

8、失，判断进入硬膜外间隙力消失，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，过程顺利退出穿刺针，重新进行穿刺，过程顺利术后术后4小时，诉左大腿外侧疼痛伴痉挛性抽小时，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Page 27Case 激素激素B族维生素族维生素针灸、理疗针灸、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Page 28ProgressPage 29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

9、版社Anesthesia Miller RDHandbook of AnesthesiologyMark R.Ezekiel,MD,MSReferencesPage 30Curabitur elementum posuere pretium.Quisque nibh dolor,dignissim ac dignissim ut,luctus ac urna.Aliquam aliquet non massa quis tincidunt.Curabitur elementum posuere pretium.Quisque nibh dolor,dignissim ac dignissim

10、ut,luctus ac urna.Aliquam aliquet non massa quis tincidunt.Curabitur elementum posuere pretium.Quisque nibh dolor,dignissim ac dignissim ut,luctus ac urna.Aliquam aliquet non massa quis tincidunt.添加标题添加标题添加标题Page 31报告人：汇报部门：内容部2019year-end summary work summarizes the boutique PPTAbout the summary text input or copy here感谢您的观看