蛛网膜下腔阻滞你该知道的N件事情——病例分析模板课件

蛛网膜下腔阻滞你该知道的N件事情病例分析模板课件Page 2目录1.Concept2.Procedure3.Indication/Contraindication目录1.Concept2.Procedure3.IndPage 3目录1.Concept2.Procedure3.Indication/Contraindication目录1.Concept2.Procedure3.IndConcept蛛网膜下腔截断性阻滞Concept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。TrendyDesignincontemporarycolorsandstyles-PowerPointTemplates&Backgrounds,PowerPointDiagrams&ChartsforyourPresentationDoctors sometimes turn out to be their own best guinea pigsAnne Fawcett.5History BierTrendy Design iPage 6目录1.Concept2.Procedure3.Indication/Contraindication目录1.Concept2.Procedure3.Ind注药消毒铺巾摆体位定位穿刺调节平面L3 侧卧位 坐位 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L3 Page 8目录1.Concept2.Procedure3.Indication/Contraindication目录1.Concept2.Procedure3.IndIndication下腹，盆腔下肢肛门会阴部2-3小时内Indication下腹，盆腔下肢肛门会阴部 2-3小时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Contraindication10休克过敏中枢神经系统疾病凝血功能障碍穿刺部位炎症或感染,Page 11目录1.Concept2.Procedure3.Indication/Contraindication目录1.Concept2.Procedure3.IndPage 12Puncture relatedDrug injectionPostoperativePuncturerelatedDruginjectionPage 13HematomaSpinalPuncture RelatedMeningitisArachnoiditisAbscess1.Backorvertebralpain2.Nerverootpain3.Motor/sensorydeficitsorsphincterdysfunction.4.Paraplegiaorparalysis.Bloodculture,CT,MRIAntibioticsHematomaSpinalPunctureRelatedPage 14HematomaSpinalPuncture RelatedHematomaSpinalPunctureRelatedPage 15NerveRootSpinalPreventionObservationPuncture RelatedNerveRootSpinalPreventionObsePage 16HematomaSpinal1.Venousplexus2.Pregnancy/AVM3.SubarachnoidhemorrhagePuncture RelatedHematomaSpinal1.VenousplexusPPage 17HematomaSpinal1.Spinal 1:220,0002.Epidural 1:150,0003.AbnormalcoagulationPuncture RelatedHematomaSpinal1.Spinal1:220,Page 18Drug Injection心血管效应2呼吸抑制3马尾综合征4恶心呕吐1DrugInjection心血管效应2呼吸抑制3马尾综合征Page 19Drug InjectionCardiacarrestLowBPDrugInjectionCardiacarrestLoPage 20PhrenicnerveRespiratorydepressionDrug InjectionPhrenicnerveDrugInjectionPage 21PostoperativePostduralPunctureHeadache(PDPH)Transientneurologicsymptoms(TNS)UrinaryRetentionBackachePostoperativePostduralPuncturPage 22PostduralPunctureHeadache(PDPH)Treatment1.OralAnalgesics2.Bedrest3.Hydration4.Caffeineinfusion5.Epiduralbloodpatch1.Frontal/Occipital2.Tinnitus/Diplopia3.UprightpositionPostduralPunctureHeadache(PPage 23Backache1.Benign,mildandself-limited2.Tylenol,ASA,NSAIDs,warmorcoldpacksBackache1.Benign,mildandselPage 241.BlockofS2-S4root2.OpioidsUrinaryRetentionTreatmentCatheterization1.BlockofS2-S4root2.OpioPage 25Transientneurologicsymptoms(TNS)1.Backpain2.Radiatingtothelegs3.Withoutsensoryormotordeficits4.AftertheresolutionoftheblockResolvesspontaneouslywithinseveraldaysTransientneurologicsymptoms(Page 26Case L2-3进针，进针约6cm有明有明显落空感，阻落空感，阻力消失，判断力消失，判断进入硬膜外入硬膜外间隙隙继续进针，诉左大腿有左大腿有过电感持感持续不不缓解解退出穿刺退出穿刺针，重新，重新进行穿刺，行穿刺，过程程顺利利术后后4小小时，诉左大腿外左大腿外侧疼痛伴疼痛伴痉挛性抽性抽搐，左足底搐，左足底轻触即有触触即有触电样感感觉女性，27岁拟在腰麻下行剖宫产手术CaseL2-3进针，进针约6cm有明显落空感，阻力消失，Page 27Case 激素激素B族族维生素生素针灸、理灸、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Case脊神经损伤术后2周：左下肢疼痛及痉挛性抽搐消失，左Page 28ProgressProgressPage 29现代麻醉学第3版人民卫生出版社临床麻醉学第4版人民卫生出版社AnesthesiaMillerRDHandbookofAnesthesiologyMark R.Ezekiel,MD,MSReferences现代麻醉学第3版人民卫生出版社ReferencesPage 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 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CurabiturelementumposuereprPage 31报告人：汇报部门：内容部2019year-endsummaryworksummarizestheboutiquePPTAboutthesummarytextinputorcopyhere感谢您的观看报告人：汇报部门：内容部2019year-