医疗护士 (32).pptx

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. Complications Concept蛛网膜下腔截断性阻滞 History 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 styles - PowerPoint Templates & Backgrounds, PowerPoint Diagrams & Charts for your PresentationDoctors sometimes turn out to be their own best guinea pigs——Anne Fawcett. 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. Procedure3. Indication/Contraindication4. Complications Indication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. Complications Complication InfectionInfectionHematomaNerve RootSpinalBleedPuncture RelatedMeningitis ArachnoiditisAbscess1. Back or vertebral pain2. Nerve root pain3. Motor / sensory deficits or sphincter dysfunction. 4. Paraplegia or paralysis. Blood culture, CT, MRIAntibiotics Spinal cordInfectionHematomaNerve RootSpinalBleedPuncture Related Nerve rootInfectionNerve RootHematomaSpinalBleedPreventionObservationPuncture Related BleedInfectionHematomaNerve RootSpinalBleed1.Venous plexus2.Pregnancy/AVM3.Subarachnoid hemorrhage Puncture Related HematomaInfectionHematomaNerve RootSpinalBleed1. Spinal 1:220,0002. Epidural 1:150,0003. Abnormal coagulationPuncture Related Drug Injection心血管效应2呼吸抑制3马尾综合征4恶心呕吐1 Drug InjectionCardiac arrestLow BP Phrenic nerveRespiratory depressionDrug Injection PostoperativePostdural Puncture Headache(PDPH)Transient neurologic symptoms(TNS)Urinary R