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1、蛛网膜下腔阻滞你该知道的N件事素彩网 -PPT模板免费下载http:/Page 2目录1. Concept2. Procedure3. Indication/Contraindication4. ComplicationsPage 3目录1. Concept2. Procedure3. Indication/Contraindication4. ComplicationsConcept蛛网膜下腔截断性阻滞5History1898 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 sty

2、les - PowerPoint Templates & Backgrounds, PowerPoint Diagrams & Charts for your PresentationDoctors sometimes turn out to be their own best guinea pigsAnne Fawcett.Page 6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L3 侧卧位 坐位 Page 8目录1. Concept2. Procedure3.

3、Indication/Contraindication4. ComplicationsIndication下腹，盆腔下肢肛门会阴部 2-3小时内10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ContraindicationPage 11目录1. Concept2. Procedure3. Indication/Contraindication4. ComplicationsPage 12ComplicationPage 13InfectionInfectionHematomaNerve Roo

4、tSpinalBleedPuncture RelatedMeningitis ArachnoiditisAbscess1. Back or vertebral pain2. Nerve root pain3. Motor / sensory deficits or sphincter dysfunction. 4. Paraplegia or paralysis. Blood culture, CT, MRIAntibioticsPage 14Spinal cordInfectionHematomaNerve RootSpinalBleedPuncture RelatedPage 15Nerv

5、e rootInfectionNerve RootHematomaSpinalBleedPreventionObservationPuncture RelatedPage 16BleedInfectionHematomaNerve RootSpinalBleed1.Venous plexus2.Pregnancy/AVM3.Subarachnoid hemorrhage Puncture RelatedPage 17 HematomaInfectionHematomaNerve RootSpinalBleed1. Spinal 1:220,0002. Epidural 1:150,0003.

6、Abnormal coagulationPuncture RelatedPage 18Drug Injection心血管效应2呼吸抑制3马尾综合征4恶心呕吐1Page 19Drug InjectionCardiac arrestLow BPPage 20Phrenic nerveRespiratory depressionDrug InjectionPage 21PostoperativePostdural Puncture Headache(PDPH)Transient neurologic symptoms(TNS)Urinary RetentionBackachePage 22Postd

7、ural Puncture Headache (PDPH) Treatment 1. Oral Analgesics 2. Bed rest 3. Hydration 4. Caffeine infusion 5. Epidural blood patch 1.Frontal/Occipital2.Tinnitus/Diplopia3.Upright positionPage 23Backache1.Benign, mild and self-limited2.Tylenol, ASA, NSAIDs, warm or cold packsClinical sign of a more ser

8、ious complication?Page 241.Block of S2-S4 root 2.Opioids Urinary RetentionTreatmentCatheterization Page 25Transient neurologic symptoms(TNS)1.Back pain2.Radiating to the legs3.Without sensory or motor deficits 4.After the resolution of the block Resolves spontaneously within several daysPage 26Case 女性，27岁拟在腰麻下行剖宫产手术Page 27Case 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 28ProgressPage 29现代麻醉学 第3版 人民