蛛网膜下腔阻滞.ppt

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1、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-

2、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.Pr

3、ocedure3.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.ComplicationsComplicationPuncturer

4、elatedDruginjectionPostoperativeInfectionInfectionHematomaNerveRootSpinalBleedPunctureRelatedMeningitisArachnoiditisAbscess1.Backorvertebralpain2.Nerverootpain3.Motor/sensorydeficitsorsphincterdysfunction.4.Paraplegiaorparalysis.Bloodculture,CT,MRIAntibi

5、oticsSpinalcordInfectionHematomaNerveRootSpinalBleedPunctureRelatedNerverootInfectionNerveRootHematomaSpinalBleedPreventionObservationPunctureRelatedBleedInfectionHematomaNerveRootSpinalBleed1.Venousplexus2.Pregnancy/AVM3.SubarachnoidhemorrhagePunctureRe

6、latedHematomaInfectionHematomaNerveRootSpinalBleed1.Spinal1:220,0002.Epidural1:150,0003.AbnormalcoagulationPunctureRelatedDrugInjection心血管效应2呼吸抑制3马尾综合征4恶心呕吐1DrugInjectionCardiacarrestLowBPPhrenicnerveRespiratorydepressionDrugInjectionPostoperativePostdur

7、alPunctureHeadache(PDPH)Transientneurologicsymptoms(TNS)UrinaryRetentionBackachePostduralPunctureHeadache(PDPH)Treatment1.OralAnalgesics2.Bedrest3.Hydration4.Caffeineinfusion5.Epiduralbloodpatch1.Frontal/Occipital2.Tinnitus/Diplopia3.UprightpositionBacka

8、che1.Benign,mildandself-limited2.Tylenol,ASA,NSAIDs,warmorcoldpacksClinicalsignofamoreseriouscomplication?1.BlockofS2-S4root2.OpioidsUrinaryRetentionTreatmentCatheterizationTransientneurologicsymptoms(TNS)1.Backpain2.Radia