PPT医学课件腰穿提高篇医学知识专题讲座讲义

腰穿解剖一定要弄清体位一定要摆好间隙一定要摸准进针一定要垂直心理一定要稳定理想与现实是有差距的体位:lateraldecubituspositionThepatientisplacedcurledonhisside,onafirmsurface,withhiskneesflexeduptothechestandneckflexedforward.Thelumbarregionshouldbeclosetotheedgeofthebedandtheplaneofthebackandshouldersasperpendiculartothebedaspossible.体位体位体位与床面的关系：两条垂直线，一条平行线间隙DrawinganimaginarylinebetweenthetwoposterioriliaccrestswillallowidentificationoftheL3-4orL4-5interspaces.确定中点进针Insertspinalneedle,withstyletinplace,alongthemidlinewithbevelfacingupwards(assumeslateraldecubituspositioning).Directtheneedleslightlycephaladalonganimaginarylinetowardstheumbilicus.进针理想与现实还是有差距的进针层次矢状面Sagittalsectionoflumbarvertebraeillustratingthecourseofthelumbarpunctureneedlethroughskin(1),subcutaneoustissue(2),supraspinousligament(3),interspinousligament(5)betweenthespinousprocesses(4),ligamentumflavum(6),duramater(8),intothesubarachnoidspaceandbetweenthenerverootsofthecaudaequina(7).Lumbarvertebralbodies(9),intervertebraldisc(10),andlumbarpunctureneedle(11).水平面Horizontalsectionoflumbarvertebraillustratingthecourseofthelumbarpunctureneedlethroughskin(1),subcutaneoustissue(2),betweenthespinousprocesses(3)andlaminae(4),ligamentumflavum(5),epiduralspace(6),duramater(7),intothesubarachnoidspaceandbetweenthenerverootsofthecaudaequina(8).Lumbarvertebralbody(9)andlumbarpunctureneedle(10).进针心理家属回避不要分心：不要象有些人风一样飘来飘去，一会接电话，一会和别人开玩笑切忌大意：有时候在给自己已经穿过的患者再次腰穿时，由于思想上放松警惕，往往会带来不顺利总结参考文献BoonJM,AbrahamsPH,MeiringJH,etal.Lu