超声引导下竖脊肌阻滞在临床应用ppt课件

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,2017-8-12,1,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,2,筋膜平面阻滞Fascialplaneblocks,PECSblockQuadratuslumborumblockSerratusplaneblockTransversusabdominisplaneblock,Theerectorspinaeplaneblock:planeandsimple.El-BoghdadlyK,PawaA.Anaesthesia.2017Apr;72(4):434-438.,3,“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,4,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,5,超声引导下竖脊肌平面阻滞在胸科手术的临床应用,6,超声引导下竖脊肌平面阻滞,ForeroM,AdhikarySD,LopezH,etal.TheErectorSpinaePlaneBlock:ANovelAnalgesicTechniqueinThoracicNeuropathicPain.RegAnesthPainMed.2016,41(5):621-627.,7,T5横突竖脊肌平面阻滞范围,8,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,9,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,10,超声引导下竖脊肌平面阻滞在腹部手术的临床应用,11,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,12,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,13,竖脊肌平面阻滞原理,Boezaart,A.P.AtlasofPeripheralNerveblocksandAnatomyforOrthopaedicAnesthesia.2008,ForeroM,AdhikarySD,LopezH,etal.TheErectorSpinaePlaneBlock:ANovelAnalgesicTechniqueinThoracicNeuropathicPain.RegAnesthPainMed.2016,41(5):621-627.,14,竖脊肌平面阻滞解剖示意图,ChinKJ,MalhasL,PerlasA.TheErectorSpinaePlaneBlockProvidesVisceralAbdominalAnalgesiainBariatricSurgery:AReportof3Cases.RegAnesthPainMed.2017,15,竖脊肌平面阻滞与后椎板阻滞,PfeifferG1,OppitzN,SchneS,etal.Analgesiaoftheaxillausingaparavertebralcatheterinthelaminatechnique.Anaesthesist.2006Apr;55(4):423-7.JttnerT1,WerdehausenR,HermannsH,etal.Theparavertebrallaminatechnique:anewregionalanesthesiaapproachforbreastsurgery.JClinAnesth.2011Sep;23(6):443-50.,16,超声引导下竖脊肌平面阻滞在脊柱手术的临床应用,17,CorrespondenceClinicalexperiencesofultrasound-guidederectorspinaeplaneblockforthoracicvertebrasurgery,ContentslistsavailableatScienceDirect,)ournalofClinicalAnesthesia,banzhtntrna,RhomBoidUI|QFFfHJSEl9,18,总结,胸腰筋膜在麻醉/疼痛领域有广阔的研究空间,竖脊肌