蛛网膜下腔阻滞 医学培训课件

蛛网膜下腔阻滞——你该知道的N件事目录1.Concept2.Procedure3.Indication/Contraindication4.Complications目录1.Concept2.Procedure3.Indication/Contraindication4.ComplicationsConcept蛛网膜下腔截断性阻滞HistoryBier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&Backgrounds,PowerPointDiagrams&ChartsforyourPresentationDoctorssometimesturnouttobetheirownbestguineapigs——AnneFawcett.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蛛网膜下腔阻滞流程图L3

侧卧位坐位

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Contraindication目录1.Concept2.Procedure3.Indication/Contraindication4.ComplicationsComplicationPuncturerelatedDruginjectionPostoperativeInfectionInfectionHematomaNerveRootSpinalBleedPunctureRelatedMeningitisArachnoiditisAbscess1.Backorvertebralpain2.Nerverootpain3.Motor/sensorydeficitsorsphincterdysfunction.4.Paraplegiaorparalysis.Bloodculture,CT,MRIAntibioticsSpinalcordInfectionHematomaNerveRootSpinalBleedPunctureRelatedNerverootInfectionNerveRootHematomaSpinalBleedPreventionObservationPunctureRelatedBleedInfectionHematomaNerveRootSpinalBleed1.Venousplexus2.Pregnancy/AVM3.SubarachnoidhemorrhagePunctureRelatedHematomaInfectionHematomaNerveRootSpinalBleed1.Spinal

1:220,0002.Epidural

1:150,0003.AbnormalcoagulationPunctureRelatedDrugInjection心血管效应2呼吸抑制3马尾综合征4恶心呕吐1DrugInjectionCardiacarrestLowBPPhrenicnerveRespiratorydepressionDrugInjectionPostoperativePostduralPunctureHeadache(PDPH)Transientneurologicsymptoms(TNS)UrinaryRetentionBackachePostdural

PunctureHeadache(PDPH)Treatment1.OralAnalgesics2.Bedrest3.Hydration4.Caffeineinfusion5.Epiduralbloodpatch1.Frontal/Occipital2.Tinnitus/Diplopia3.UprightpositionBackache1.Benign,mildandself-limited2.Tylenol,ASA,NSAIDs,warmorcoldpacksClinicalsignofamoreseriouscomplication?1.BlockofS2-S4root

2.OpioidsUrinaryRetentionTreatmentCatheterization

Transientneurologicsymptoms(TNS)1.Backpain2.Radiatingtothelegs3.Withoutsensoryormotordeficits4.Aftertheresolutionoftheblock

ResolvesspontaneouslywithinseveraldaysCaseL2-3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