蛛网膜下腔阻滞你该知道的N见事情――病例分析说明PPT模板

蛛网膜下腔阻滞——你该知道的N件事Page2目录1.Concept2.Procedure3.Indication/Contraindication4.ComplicationsPage3目录1.Concept2.Procedure3.Indication/Contraindication4.ComplicationsConceptHistory1898Bier1899把小剂量的可卡因注射到脊髓周围的1900脑脊液中。在动物和人身上都取得了1901成功。TrendyDesignincontemporarycolorsandstyles-PowerPointTemplates&Backgrounds,PowerPointDiagrams&ChartsforyourPresentationDoctorssometimesturnouttobetheirownbestguineapigs——AnneFawcett.Page6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Page8目录1.Concept2.Procedure3.Indication/Contraindication4.ComplicationsIndication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ContraindicationPage11目录1.Concept2.Procedure3.Indication/Contraindication4.ComplicationsPage12ComplicationPuncturerelatedDruginjectionPostoperativePage13InfectionInfectionHematomaNerveRootSpinalBleedPunctureRelatedMeningitisArachnoiditisAbscess1.Backorvertebralpain2.Nerverootpain3.Motor/sensorydeficitsorsphincterdysfunction.4.Paraplegiaorparalysis.Bloodculture,CT,MRIAntibioticsPage14SpinalcordInfectionHematomaNerveRootSpinalBleedPunctureRelatedPage15NerverootInfectionNerveRootHematomaSpinalBleedPreventionObservationPunctureRelatedPage16BleedInfectionHematomaNerveRootSpinalBleed1.Venousplexus2.Pregnancy/AVM3.SubarachnoidhemorrhagePunctureRelatedPage17HematomaInfectionHematomaNerveRootSpinalBleed1.Spinal1:220,0002.Epidural1:150,0003.AbnormalcoagulationPunctureRelatedPage18DrugInjection心血管效应呼吸抑制马尾综合征恶心呕吐Page19DrugInjectionCardiacarrestLowBPPage20PhrenicnerveRespiratorydepressionDrugInjectionPage21PostoperativePostduralPunctureHeadache(PDPH)Transientneurologicsymptoms(TNS)UrinaryRetentionBackachePage22PostduralPunctureHeadache(PDPH)Treatment1.OralAnalgesics2.Bedrest3.Hydration4.Caffeineinfusion5.Epiduralbloodpatch1.Frontal/Occipital2.Tinnitus/Diplopia3.UprightpositionPage23Backache1.Benign,mildandself-limited2.Tylenol,ASA,NSAIDs,warmorcoldpacksClinicalsignofamoreseriouscomplication?Page241.BlockofS2-S4root2.OpioidsUrinaryRetentionTreatmentCatheterizationPage25Transientneurologicsymptoms(TNS)1.Backpain2.Radiatingtothelegs3.Withoutsensoryormotordeficits4.AftertheresolutionoftheblockResolvesspontaneouslywithinseveraldaysPage26CaseL2-3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Page27Case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Page28ProgressPage29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AnesthesiaMillerRDHandbookofAnesthesiologyMarkR.Ezekiel,MD,MSReferences