2017超声引导下竖脊肌阻滞在临床应用-马丹旭

超声引导下竖脊肌平面阻滞的临床应用首都医科大学附属北京朝阳医院麻醉科马丹旭2017-8-12内容一、筋膜和筋膜平面阻滞概况二、竖脊肌平面阻滞在胸科手术的应用三、竖脊肌平面阻滞在腹部手术的应用四、竖脊肌平面阻滞在脊柱手术的应用筋膜平面阻滞FascialplaneblocksPECSblockQuadratuslumborumblockSerratusplaneblockTransversusabdominisplaneblockTheerectorspinaeplaneblock:planeandsimple.El-BoghdadlyK,PawaA.Anaesthesia.2017Apr;72(4):434-438.“诡异的筋膜”麻醉为筋膜平面阻滞提供空间疼痛人体生物力学调控胸腰筋膜麻醉腰方肌阻滞竖脊肌平面阻滞胸腰筋膜平面阻滞疼痛调节腰臀部和脊柱相关软组织张力肌筋膜炎（急性腰肌扭伤）神经病理性疼痛超声引导下竖脊肌平面阻滞在胸科手术的临床应用超声引导下竖脊肌平面阻滞ForeroM,AdhikarySD,LopezH,etal.TheErectorSpinaePlaneBlock:ANovelAnalgesicTechniqueinThoracicNeuropathicPain.RegAnesthPainMed.2016,41(5):621-627.T5横突竖脊肌平面阻滞范围T5横突竖脊肌平面阻滞范围验证竖脊肌平面阻滞的有效性和安全性——随机对照研究持续竖脊肌平面阻滞首次剂量25ml0.5%罗哌卡因；镇痛泵8ml/h0.2%罗哌卡因，bolus5ml，锁定60min超声引导下竖脊肌平面阻滞在腹部手术的临床应用双侧T7竖脊肌平面阻滞用于腹壁疝手术镇痛双侧T7竖脊肌平面阻滞用于减肥手术镇痛双侧T8持续竖脊肌平面阻滞用于膀胱前列腺切除术术后第1天术后第2天术后第4天每侧首次剂量：3ml2%利多卡因，10ml0.25%布比卡因；置管，镇痛泵6ml/h0.1%布比卡因；手术结束前10ml0.25%布比卡因竖脊肌平面阻滞原理Boezaart,A.P.AtlasofPeripheralNerveblocksandAnatomyforOrthopaedicAnesthesia.2008ForeroM,AdhikarySD,LopezH,etal.TheErectorSpinaePlaneBlock:ANovelAnalgesicTechniqueinThoracicNeuropathicPain.RegAnesthPainMed.2016,41(5):621-627.竖脊肌平面阻滞解剖示意图ChinKJ,MalhasL,PerlasA.TheErectorSpinaePlaneBlockProvidesVisceralAbdominalAnalgesiainBariatricSurgery:AReportof3Cases.RegAnesthPainMed.2017竖脊肌平面阻滞与后椎板阻滞1.PfeifferG1,OppitzN,SchöneS,etal.Analgesiaoftheaxillausingaparavertebralcatheterinthelaminatechnique.Anaesthesist.2006Apr;55(4):423-7.2.JüttnerT1,WerdehausenR,HermannsH,etal.Theparavertebrallaminatechnique:anewregionalanesthesiaapproachforbreastsurgery.JClinAnesth.2011Sep;23(6):443-50.超声引导下竖脊肌平面阻滞在脊柱手术的临床应用CorrespondenceClinicalexperiencesofultrasound-guidederectorspinaeplaneblockforthoracicvertebrasurgeryContentslistsavailableatScienceDirect)ournalofClinicalAnesthesiab•anzhtnt‹rnaRhomBoidUI|QFFfHJSEl9总结•胸腰筋膜在麻醉/疼痛领域有广阔的研究空间•竖脊肌平面阻滞优点：简便（横突/肌肉间隙图像容易识别）安全（无气胸/硬膜外血肿/脊髓损伤的风险；受凝血功能要求较小；单侧阻滞，对循环和呼吸功能影响小）；有效（镇痛效果）Thankyou!