1、蛛网膜下腔阻滞你该知道的N件事Page 2目录1. Concept2. Procedure3. Indication/Contraindication4. ComplicationsPage 3目录1. Concept2. Procedure3. Indication/Contraindication4. ComplicationsConcept蛛网膜下腔截断性阻滞History1898 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&Bac
2、kgrounds,PowerPointDiagrams&ChartsforyourPresentationDoctors sometimes turn out to be their own best guinea pigsAnne Fawcett.Page 6目录1. Concept2. Procedure3. Indication/Contraindication4. Complications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/Contraindication4. Complicat
3、ionsIndication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ContraindicationPage 11目录1. Concept2. Procedure3. Indication/Contraindication4. ComplicationsPage 12ComplicationPuncturerelatedDruginjectionPostoperativePage 13InfectionInfectionHematomaNerveRootS
4、pinalBleedPunctureRelatedMeningitisArachnoiditisAbscess1. Backorvertebralpain2. Nerverootpain3. Motor/sensorydeficitsorsphincterdysfunction.4. Paraplegiaorparalysis.Bloodculture,CT,MRIAntibioticsPage 14Spinal cordInfectionHematomaNerveRootSpinalBleedPunctureRelatedPage 15Nerve rootInfectionNerveRoot
5、HematomaSpinalBleedPreventionObservationPunctureRelatedPage 16BleedInfectionHematomaNerveRootSpinalBleed1.Venousplexus2.Pregnancy/AVM3.SubarachnoidhemorrhagePunctureRelatedPage 17 HematomaInfectionHematomaNerveRootSpinalBleed1. Spinal 1:220,0002.Epidural 1:150,0003.AbnormalcoagulationPunctureRelated
6、Page 18DrugInjection心血管效应呼吸抑制马尾综合征恶心呕吐Page 19DrugInjectionCardiacarrestLowBPPage 20PhrenicnerveRespiratorydepressionDrugInjectionPage 21PostoperativePostduralPunctureHeadache(PDPH)Transientneurologicsymptoms(TNS)UrinaryRetentionBackachePage 22PostduralPunctureHeadache(PDPH) Treatment1.OralAnalgesics
7、2.Bedrest3.Hydration4.Caffeineinfusion5.Epiduralbloodpatch1.Frontal/Occipital2.Tinnitus/Diplopia3.UprightpositionPage 23Backache1.Benign,mildandself-limited2.Tylenol,ASA,NSAIDs,warmorcoldpacksClinicalsignofamoreseriouscomplication?Page 241.BlockofS2-S4root2.OpioidsUrinaryRetentionTreatmentCatheteriz
8、ationPage 25Transientneurologicsymptoms(TNS)1.Backpain2.Radiatingtothelegs3.Withoutsensoryormotordeficits4.AftertheresolutionoftheblockResolvesspontaneouslywithinseveraldaysPage 26CaseL2-3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Page 27Case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 人民卫生出版社Anesthesia Miller RDHandbookofAnesthesiologyMark R. Ezekiel, MD, MSReferencesPage 30Thank you!
