超声引导上肢神经阻滞课件

,8/27/2019,#,超声引导 上肢神经阻滞,2016,.,12,.,17,.,1,超声引导 上肢神经阻滞2016.12.17.1,上海市第六人民医,院,Shangha,i,Sixt,h,P,e,opl,e,s,Ho,s,pita,l,2,上海市第六人民医院2,上海市第六人民医,院,Shangha,i,Sixt,h,P,e,opl,e,s,Ho,s,pita,l,上肢的神经支,配,3,上海市第六人民医院上肢的神经支配3,上海市第六人民医,院,Shangha,i,Sixt,h,P,e,opl,e,s,Ho,s,pita,l,病例一：桡骨远端骨折内固定手,术,4,上海市第六人民医院病例一：桡骨远端骨折内固定手术4,上海市第六人民医,院,Shangha,i,Sixt,h,P,e,opl,e,s,Ho,s,pita,l,神经阻滞入路选,择,适应,症,肩部、锁骨,、,上臂近端手,术,臂丛神经置,管,肱骨中,段,以下上,肢,肘部以,下,臂丛神经置,管,同锁骨下入,路,缺,点,缺乏超声引,导,阻滞较,难,1.,受体位限,制,2.,需要单独,阻,滞肌皮神,经,并发,症,刺伤锁骨下血管,刺伤腋血,管,5,上海市第六人民医院神经阻滞入路选择适应症肩部、锁骨、上臂近,上海市第六人民医,院,Shangha,i,Sixt,h,P,e,opl,e,s,Ho,s,pita,l,6,上海市第六人民医院6,上海市第六人民医,院,Shangha,i,Sixt,h,P,e,opl,e,s,Ho,s,pita,l,7,上海市第六人民医院7,上海市第六人民医,院,Shangha,i,Sixt,h,P,e,opl,e,s,Ho,s,pita,l,8,上海市第六人民医院8,上海市第六人民医,院,Shangha,i,Sixt,h,P,e,opl,e,s,Ho,s,pita,l,Ur,m,e,y,WF,Talt,s,KH,Sharroc,k,NE,.,On,e,hundre,d,percen,t,incidenc,e,o,f,he,m,idiaphrag,m,ati,c,paresi,s,associate,d,wit,h,interscalen,e,brachia,l,plexu,s,anesthesi,a,a,s,diagnose,d,b,y,ultrasonography,.,Anest,h,Anal,g,1991,;,72,:,498-503,.,9,上海市第六人民医院Urmey WF,Talts KH,S,上海市第六人民医,院,Shangha,i,Sixt,h,P,e,opl,e,s,Ho,s,pita,l,膈神经阻滞,US,V,S,NS,10,上海市第六人民医院膈神经阻滞USVSNS10,上海市第六人民医,院,Shangha,i,Sixt,h,P,e,opl,e,s,Ho,s,pita,l,膈神经阻滞,5,M,L,V,S,10M,L,11,上海市第六人民医院膈神经阻滞5MLVS10ML11,上海市第六人民医,院,Shangha,i,Sixt,h,P,e,opl,e,s,Ho,s,pita,l,膈神经阻滞,ex,t,r,a,f,ascial,injec,t,ion,12,上海市第六人民医院膈神经阻滞extrafascial in,上海市第六人民医,院,Shangha,i,Sixt,h,P,e,opl,e,s,Ho,s,pita,l,锁骨,上,13,上海市第六人民医院锁骨上13,上海市第六人民医,院,Shangha,i,Sixt,h,P,e,opl,e,s,Ho,s,pita,l,锁骨,下,14,上海市第六人民医院锁骨下14,上海市第六人民医,院,Shangha,i,Sixt,h,P,e,opl,e,s,Ho,s,pita,l,腋,路,15,上海市第六人民医院腋路15,上海市第六人民医,院,Shangha,i,Sixt,h,P,e,opl,e,s,Ho,s,pita,l,神经阻滞的选,择,肌间沟,+腋路,取长补短,Nerve,s,Grou,p S,(n=40,),Grou,p C,(n=40,),P,valu,e,A,x,illa,ry,Radial Me,d,ia,n,Ul,n,a,r,M,u,sc,u,l,o,c,u,ta,n,e,ous,MCN,A,MCNF,A,In,tercost,obr,ac,h,ial T,o,tal,0,/,7,/,3,3,0,/,10,/,3,0,0.41,2,0,/,6,/,3,4,0,/,8,/,3,2,0.55,6,2,/,9,/,2,9,1,/,13,/,2,6,0.87,8,9,/,18,/,1,3,0,/,12,/,2,8,0.00,0,0,/,15,/,2,5,0,/,18,/,2,2,0.49,6,8,/,21,/,1,1,0,/,12,/,2,8,0.00,3,9,/,19,/,1,2,0,/,10,/,3,0,0.01,3,40,/,0,/0,0,/,9,/,3,1,0.00,0,68,/,95,/,15,7,1,/,92,/,22,7,0.00,0,16,上海市第六人民医院神经阻滞的选择肌间沟+腋路NervesGr,上海市第六人民医,院,Shangha,i,Sixt,h,P,e,opl,e,s,Ho,s,pita,l,病例,二,17,上海市第六人民医院病例二17,上海市第六人民医,院,Shangha,i,Sixt,h,P,e,opl,e,s,Ho,s,pita,l,麻醉遇到的问,题,18,上海市第六人民医院麻醉遇到的问题18,上海市第六人民医,院,Shangha,i,Sixt,h,P,e,opl,e,s,Ho,s,pita,l,皮肤、肌肉、锁骨的神经支,配,19,上海市第六人民医院皮肤、肌肉、锁骨的神经支配19,上海市第六人民医,院,Shangha,i,Sixt,h,P,e,opl,e,s,Ho,s,pita,l,锁骨上神,经,胸内侧神,经,胸外侧神,经,胸锁乳突肌肌,支,锁骨下神,经,副神经斜方肌,支,需要阻滞的神,经,20,上海市第六人民医院锁骨上神经需要阻滞的神经20,上海市第六人民医,院,Shangha,i,Sixt,h,P,e,opl,e,s,Ho,s,pita,l,超声引导锁骨上神经&臂丛阻,滞,1,前斜角,肌,2,中斜角,肌,3,后斜角,肌,4,胸锁乳突,肌,5,颈外静,脉,6,臂,丛,7,锁骨上神,经,21,上海市第六人民医院超声引导锁骨上神经&臂丛阻滞1 前斜角肌,上海市第六人民医,院,Shangha,i,Sixt,h,P,e,opl,e,s,Ho,s,pita,l,病例,三,22,上海市第六人民医院病例三22,上海市第六人民医,院,Shangha,i,Sixt,h,P,e,opl,e,s,Ho,s,pita,l,病例,四,23,上海市第六人民医院病例四23,上海市第六人民医,院,Shangha,i,Sixt,h,P,e,opl,e,s,Ho,s,pita,l,Do,u,b,l,e,-,c,r,u,sh,双重打,击,Upto,n,AR,M,cComa,s,AJ,.,Th,e,doub,le,crus,h,in,nerv,e,entrapmen,t,syndromes,.,Lancet,.,197,3,Au,g,18;2(7825):359-62,.,Osterma,n,AL,.,Th,e,doub,le,crus,h,syndrome,.,Ortho,p,C,lin,Nort,h,Am,.,198,8,Jan;19(1):147-55,.,0,.,W,illi,a,m,J,Joh,n,C,.,Th,e,doub,le,crus,h,syndrome,.J,Han,d,Sur,g,Am,.,201,3,Apr;38(4):799-801,.,Kan,e,P,M,Dan,i,e,ls,AH,Ake,l,ma,n,E,.,Doub,le,crus,h,syndrome,.J,A,m,Aca,d,Ortho,p,Surg,.,201,5,Sep;23(9):558-62,.,24,上海市第六人民医院Double-crush双重打击Upto,上海市第六人民医,院,Shangha,i,Sixt,h,P,e,opl,e,s,Ho,s,pita,l,手术部位皮肤神经支,配,25,上海市第六人民医院手术部位皮肤神经支配25,上海市第六人民医,院,Shangha,i,Sixt,h,P,e,opl,e,s,Ho,s,pita,l,臂内侧皮神经,、,前臂内侧皮神经阻,滞,26,上海市第六人民医院臂内侧皮神经、前臂内侧皮神经阻滞26,上海市第六人民医,院,Shangha,i,Sixt,h,P,e,opl,e,s,Ho,s,pita,l,腕管综合,征,27,上海市第六人民医院腕管综合征27,上海市第六人民医,院,Shangha,i,Sixt,h,P,e,opl,e,s,Ho,s,pita,l,总,结,28,上海市第六人民医院总 结28,上海市第六人民医,院,Shangha,i,Sixt,h,P,e,opl,e,s,Ho,s,pita,l,谢谢聆听,29,上海市第六人民医院谢谢聆听29,