蛛网膜下腔阻滞 你该知道的N件事,目录,1. Concept,2. Procedure,3. Indication/Contraindication,4. Complications,目录,1. Concept,2. Procedure,3. Indication/Contraindication,4. Complications,Concept,蛛网膜下腔,截断性阻滞,History,Trendy Design in contemporary colors and styles - PowerPoint Templates & Backgrounds, PowerPoint Diagrams & Charts for your Presentation,Doctors sometimes turn out to be their own best guinea pigsAnne Fawcett.,目录,1. Concept,2. Procedure,3. Indication/Contraindication,4. 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,目录,1. Concept,2. Procedure,3. Indication/Contraindication,4. Complications,Indication,下腹，盆腔,下肢,肛门会阴部,2-3小时内,Contraindication,目录,1. Concept,2. Procedure,3. Indication/Contraindication,4. Complications,Complication,Infection,Infection,Hematoma,Nerve Root,Spinal,Bleed,Puncture Related,Meningitis Arachnoiditis Abscess,1. Back or vertebral pain 2. Nerve root pain 3. Motor / sensory deficits or sphincter dysfunction. 4. Paraplegia or paralysis.,Blood culture, CT, MRI,Antibiotics,Spinal cord,Infection,Hematoma,Nerve Root,Spinal,Bleed,Puncture Related,Nerve root,Infection,Nerve Root,Hematoma,Spinal,Bleed,Prevention,Observation,Puncture Related,Bleed,Infection,Hematoma,Nerve Root,Spinal,Bleed,1.Venous plexus 2.Pregnancy/AVM 3.Subarachnoid hemorrhage,Puncture Related,Hematoma,Infection,Hematoma,Nerve Root,Spinal,Bleed,1. Spinal 1:220,000 2. Epidural 1:150,000 3. Abnormal coagulation,Puncture Related,Drug Injection,Drug Injection,Cardiac arrest,Low BP,Phrenic nerve Respiratory depression,Drug Injection,Postoperative,Postdural Puncture Headache(PDPH),Transient neurologic symptoms(TNS),Urinary Retention,Backache,Postdural Puncture Headache (PDPH),Treatment 1. Oral Analgesics 2. Bed rest 3. Hydration 4. Caffeine infusion 5. Epidural blood patch,1.Frontal/Occipital 2.Tinnitus/Diplopia 3.Upright position,Backache,1.Benign, mild and self-limited 2.Tylenol, ASA, NSAIDs, warm or cold packs,Clinical sign of a more serious complication?,1.Block of S2-S4 root 2.Opioids,Urinary Retention,Treatment Catheterization,Transient neurologic symptoms(TNS),1.Back pain 2.Radiating to the legs 3.Without sensory or motor deficits 4.After the resolution of the block,Resolves spontaneously within several days,Case,女性，27岁 拟在腰麻下行剖宫产手术,Case,激素 B族维生素 针灸、理疗,脊神经损伤,术后2周：左下肢疼痛及痉挛性抽搐消失，左足底触觉敏感明显减退,Progress,现代麻醉学 第3版 人民卫生出版社 临床麻醉学 第4版 人民卫生出版社 Anesthesia Miller RD Handbook of Anesthesiology Mark R. Ezekiel, MD, MS,References,