蛛網(wǎng)膜下腔阻滯——你該知道的N件事目錄1.Concept2.Procedure3.Indication/Contraindication4.Complications目錄1.Concept2.Procedure3.Indication/Contraindication4.ComplicationsConcept蛛網(wǎng)膜下腔截斷性阻滯HistoryBier把小劑量的可卡因注射到脊髓周圍的腦脊液中。在動物和人身上都取得了成功。TrendyDesignincontemporarycolorsandstyles-PowerPointTemplates&Backgrounds,PowerPointDiagrams&ChartsforyourPresentationDoctorssometimesturnouttobetheirownbestguineapigs——AnneFawcett.目錄1.Concept2.Procedure3.Indication/Contraindication4.Complications注藥消毒鋪巾擺體位定位穿刺調(diào)節(jié)平面蛛網(wǎng)膜下腔阻滯流程圖L3

側(cè)臥位坐位

目錄1.Concept2.Procedure3.Indication/Contraindication4.ComplicationsIndication下腹，盆腔下肢肛門會陰部2-3小時內(nèi)休克過敏中樞神經(jīng)系統(tǒng)疾病腦脊膜炎、脊髓炎、顱壓升高凝血功能障礙穿刺部位炎癥或感染,敗血癥脊椎外傷、結(jié)核精神病/嚴(yán)重神經(jīng)官能癥/小兒不能合作的病人Contraindication目錄1.Concept2.Procedure3.Indication/Contraindication4.ComplicationsComplicationPuncturerelatedDruginjectionPostoperativeInfectionInfectionHematomaNerveRootSpinalBleedPunctureRelatedMeningitisArachnoiditisAbscess1.Backorvertebralpain2.Nerverootpain3.Motor/sensorydeficitsorsphincterdysfunction.4.Paraplegiaorparalysis.Bloodculture,CT,MRIAntibioticsSpinalcordInfectionHematomaNerveRootSpinalBleedPunctureRelatedNerverootInfectionNerveRootHematomaSpinalBleedPreventionObservationPunctureRelatedBleedInfectionHematomaNerveRootSpinalBleed1.Venousplexus2.Pregnancy/AVM3.SubarachnoidhemorrhagePunctureRelatedHematomaInfectionHematomaNerveRootSpinalBleed1.Spinal

1:220,0002.Epidural

1:150,0003.AbnormalcoagulationPunctureRelatedDrugInjection心血管效應(yīng)2呼吸抑制3馬尾綜合征4惡心嘔吐1DrugInjectionCardiacarrestLowBPPhrenicnerveRespiratorydepressionDrugInjectionPostoperativePostduralPunctureHeadache(PDPH)Transientneurologicsymptoms(TNS)UrinaryRetentionBackachePostdural

PunctureHeadache(PDPH)Treatment1.OralAnalgesics2.Bedrest3.Hydration4.Caffeineinfusion5.Epiduralbloodpatch1.Frontal/Occipital2.Tinnitus/Diplopia3.UprightpositionBackache1.Benign,mildandself-limited2.Tylenol,ASA,NSAIDs,warmorcoldpacksClinicalsignofamoreseriouscomplication?1.BlockofS2-S4root

2.OpioidsUrinaryRetentionTreatmentCatheterization

Transientneurologicsymptoms(TNS)1.Backpain2.Radiatingtothelegs3.Withoutsensoryormotordeficits4.Aftertheresolutionoftheblock

ResolvesspontaneouslywithinseveraldaysCaseL2-3進針，進針約6cm有明顯落空感，阻力消失，判斷進入硬膜外間隙繼續(xù)進針，訴左大腿有過電感持續(xù)不緩解退出穿刺針，重新進行穿刺，過程順利術(shù)后4小時，訴左大腿外側(cè)疼痛伴痙攣性抽搐，左足底輕觸即有觸電樣感覺女性，27歲擬在腰麻下行剖宮產(chǎn)手術(shù)Case激素B族維生素針灸、理療脊神經(jīng)損傷術(shù)后2周：左下肢疼痛及痙攣性抽搐消失，左足底觸覺敏感明顯減退Progress現(xiàn)代麻醉學(xué)第3版人民衛(wèi)生出版社臨床麻醉學(xué)第4版

人民衛(wèi)生出版社AnesthesiaMillerRDHandbookofAnesthesiologyMarkR.Ezeki