腰穿提高篇PPT课件

.,腰穿秘笈（成人）,.,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:lateraldecubitusposition,Thepatientisplacedcurledonhisside,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.L