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1、蛛网膜下腔阻滞 你该知道的N件事 Page 2 目录 1. Concept 2. Procedure 3. Indication/Contraindication 4. Complications Page 3 目录 1. Concept 2. Procedure 3. Indication/Contraindication 4. Complications Concept 蛛网膜下腔 截断性阻滞 History 1898 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。 Trendy Design in contemporary colors and st
2、yles - PowerPoint Templates & Backgrounds, PowerPoint Diagrams & Charts for your Presentation Doctors sometimes turn out to be their own best guinea pigsAnne Fawcett. Page 6 目录 1. Concept 2. Procedure 3. Indication/Contraindication 4. 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. Concept 2
3、. Procedure 3. Indication/Contraindication 4. Complications Indication 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 Contraindication Page 11 目录 1. Concept 2. Procedure 3. Indication/Contraindication 4. Complications Page 12 Complication Punctu
4、re related Drug injectionPostoperative Page 13 Infection InfectionHematomaNerve RootSpinalBleed Puncture Related Meningitis Arachnoiditis Abscess 1. Back or vertebral pain 2. Nerve root pain 3. Motor / sensory deficits or sphincter dysfunction. 4. Paraplegia or paralysis. Blood culture, CT, MRI Anti
5、biotics Page 14 Spinal cord InfectionHematomaNerve RootSpinalBleed Puncture Related Page 15 Nerve root InfectionNerve RootHematomaSpinalBleed Prevention Observation Puncture Related Page 16 Bleed InfectionHematomaNerve RootSpinalBleed 1.Venous plexus 2.Pregnancy/AVM 3.Subarachnoid hemorrhage Punctur
6、e Related Page 17 Hematoma InfectionHematomaNerve RootSpinalBleed 1. Spinal 1:220,000 2. Epidural 1:150,000 3. Abnormal coagulation Puncture Related Page 18 Drug Injection 心血管效应 2 2 呼吸抑制 3 3 马尾综合征 4 4 恶心呕吐 1 1 Page 19 Drug Injection Cardiac arrest Low BP Page 20 Phrenic nerve Respiratory depression
7、Drug Injection Page 21 Postoperative Postdural Puncture Headache(PDPH) Transient neurologic symptoms(TNS) Urinary Retention Backache Page 22 Postdural Puncture Headache (PDPH) Treatment 1. Oral Analgesics 2. Bed rest 3. Hydration 4. Caffeine infusion 5. Epidural blood patch 1.Frontal/Occipital 2.Tin
8、nitus/Diplopia 3.Upright position Page 23 Backache 1.Benign, mild and self-limited 2.Tylenol, ASA, NSAIDs, warm or cold packs Clinical sign of a more serious complication? Page 24 1.Block of S2-S4 root 2.Opioids Urinary Retention Treatment Catheterization Page 25 Transient neurologic symptoms(TNS) 1
9、.Back pain 2.Radiating to the legs 3.Without sensory or motor deficits 4.After the resolution of the block Resolves spontaneously within several days Page 26 Case L2-3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 27 Case 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 28 Progress Page 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 RD Handbook of Anesthesiology Mark R. Ezekiel, MD, MS References Page 30 Thank you!
