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1、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,Powe
2、rPointDiagrams&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
3、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/嚴重神經(jīng)官能癥/小兒不能合作的病人Contraindication目錄1.Concept2.Procedure3.Indication/Contraindication4.ComplicationsComplicationPuncturerelatedDruginjectionPostoperativeInfectionInfectionHematomaNerveRootSpinalBleedPunctureRelatedMeningitisArach
4、noiditisAbscess1.Backorvertebralpain2.Nerverootpain3.Motor/sensorydeficitsorsphincterdysfunction.4.Paraplegiaorparalysis.Bloodculture,CT,MRIAntibioticsSpinalcordInfectionHematomaNerveRootSpinalBleedPunctureRelatedNerverootInfectionNerveRootHematomaSpinalBleedPreventionObservationPunctureRe
5、latedBleedInfectionHematomaNerveRootSpinalBleed1.Venousplexus2.Pregnancy/AVM3.SubarachnoidhemorrhagePunctureRelatedHematomaInfectionHematomaNerveRootSpinalBleed1.Spinal1:220,0002.Epidural1:150,0003.AbnormalcoagulationPunctureRelatedDrugInjection心血管效應(yīng)2呼吸抑制3馬尾綜合征4惡心嘔吐1DrugInjectionCardiacarr
6、estLowBPPhrenicnerveRespiratorydepressionDrugInjectionPostoperativePostduralPunctureHeadache(PDPH)Transientneurologicsymptoms(TNS)UrinaryRetentionBackachePostduralPunctureHeadache(PDPH)Treatment1.OralAnalgesics2.Bedrest3.Hydration4.Caffeineinfusion5.Epiduralbloodpatch1.Frontal/Occipital2.T
7、innitus/Diplopia3.UprightpositionBackache1.Benign,mildandself-limited2.Tylenol,ASA,NSAIDs,warmorcoldpacksClinicalsignofamoreseriouscomplication?1.BlockofS2-S4root2.OpioidsUrinaryRetentionTreatmentCatheterizationTransientneurologicsymptoms(TNS)1.Backpain2.Radia
