椎管内麻醉-intrathecal-anesthesia

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1、椎管内麻醉NeuraxialAnesthesia夏瑞Introduction——CorrelatedAnatomy三条韧带(由外到内)棘上韧带supraspinousligament棘间韧带interspinousligament黄韧带ligamentumflavum(yellowligament)CorrelatedAnatomy脊髓由脊膜所包裹脊膜(由内至外)分为：软膜piamater蛛网膜arachnoidmater硬脊膜duramater两层：内膜、外膜硬膜外腔epiduralspace硬脊膜内、外层之间的区域蛛网膜下腔subarachnoidspace软膜和蛛网膜之间的区域

2、CorrelatedAnatomyClassificationofNeuraxialAnesthesia蛛网膜下腔阻滞麻醉SpinalAnesthesia硬膜外腔阻滞麻醉EpiduralAnesthesia蛛网膜下腔与硬膜外腔联合阻滞麻醉Combinedspinal-epiduralAnesthesia,CSEA骶管阻滞麻醉CaudalAnesthesia第一节蛛网膜下腔阻滞（脊麻)SectiononeSubarachnoidblock(spinalanesthesia)定义（definition）TheagentisinjectedintotheCSF(cerebrospinalf

3、luid)inthesubarachnoidspaceofthemeninges(thethree-layeredcoveringofthespinalcord)usingalumbarinterspaceinthevertebralcolumn.局麻药脑脊液脊神经、背根神经节及脊髓表面一、概述(outline)第一节蛛网膜下腔阻滞SectiononeSubarachnoidblock(spinalanesthesia)比重：AccordingtothedifferencesofgravitybetweenthelocalanestheticandCSFHyperbaricsolut

4、ion:ItisheavierthanCSF,anditcanbemade(重比重)bytheadditionofglucose.Hypobaricsolution:ItislighterthanCSF,anditcanbemade(轻比重)bytheadditionofsterilewater.Isobaricsolution:ItisnearlyequaltogravityofCSF,anditis(等比重)mixedwithCSF(atleast1:1).(ThegravityofCSFis1.003～1.009)概述(outline)平面：Accordingtotheleve

5、lofneuralblockadeSpinalanesthesiahighposition:Thesensoryblockade＞T4midposition:Thesensoryblockade≤T5—9lowposition:Thesensoryblockade＜T10.“saddleblock”(鞍麻）meansthatthelevelofneuralblockadeislimitedtoperineum(会阴)orhip(臀部).“Unilateralblock”meansthatthelevelofneuralblockadeislimitedtounilaterallowe

6、rextremity(单侧阻滞)一、概述(outline)二、蛛网膜下隙阻滞的机制及其对生理的影响(Themechanismofactionandphysiologicresponses)1.直接作用(Directactions):▲Thesiteofaction:Theprincipalsiteofactionisthenerveroot.▲Thesequenceofblock:AutonomicNf*sensoryNfmotorNfmyelinatedArNf*(有髓鞘的本体感觉纤维)▲Thedifferentiallevelofblock:Sympatheticblockmay

7、be2-4segmentshigherthansensoryblock,whichinturnis1-4segmentshigherthanmotorblock.Nf:nervefiber2.间接作用(全身影响):Indirectactions(systemiceffects)★Cardiovascularmanifestations——心血管系统影响SympatheticNfblockvasodilationofvenouscapacitancevess