椎管内麻醉（网站）.ppt

椎管内麻醉Neuraxial Anesthesia ;Introduction——Correlated Anatomy ;Correlated Anatomy;Correlated Anatomy; Classification of Neuraxial Anesthesia;第一节 蛛 网 膜 下 腔 阻 滞（脊麻) Section one Subarachnoid block (spinal anesthesia) ;第一节 蛛 网 膜 下 腔 阻 滞 Section one Subarachnoid block (spinal anesthesia) ;平面：According to the level of neural blockade ;二、蛛网膜下隙阻滞的机制及其对生理的影响 ;2. 间接作用(全身影响): ;Indirect actions(systemic effects) ;★ Gastrointestinal manifestations(胃肠道影响） Spinal block sympathetic block vagal tone a contracted gut with active peristasis （内脏收缩，蠕动 ） ★Urinary tract manifestations（泌尿系统影响） Renal blood flow is maintained through autoregulation, and there is little clinical effect on renal function from spinal block. 肾功能影响小 ;三、蛛网膜下腔阻滞的临床应用 ;( 二) 禁忌证(contraindications) ;( 二) 禁忌证(contraindications) ;( 二) 禁忌证(contraindications) ; （三）麻醉前准备 preanesthetic preparation;(四)常用局麻药： ;;(五)蛛网膜下腔穿刺术: ;●穿刺方法(approachs): ;;(六)阻滞平面的调节 ;★麻醉平面的影响因素 factors postulates to be related to spinal anesthetic block height 穿刺间隙 药物种类、浓度、剂量及比重 注药速度、针口方向 病人特征 Patient characteristics ;Factors Postulated to be Related to Spinal Anesthetic Block Height;Factors Postulated to be Related to Spinal Anesthetic Block Height;Factors Postulated to be Related to Spinal Anesthetic Block Height;(七)麻醉中的管理 ;●呼吸抑制(inhibition of respiration): ; 四、并发症 Complications 头痛 postoperative headache 原因：脑脊液外漏 处理：平卧至头痛消失，充分补充血容量，对症处理 尿潴留 urinary retention 原因：骶神经被阻滞 处理：导尿 较少见并发症 脑神经受累 假性脑膜炎 下肢瘫痪 ;特殊并发症;第二节 硬脊膜外阻滞麻醉 Section two Epidural anesthesia? ; 第二节 硬脊膜外阻滞 Section two Epidural anesthesia? ;二、硬膜外阻滞的作用机制及其生理影响;◆局麻药在硬膜外间隙的扩散(pervasion) ;◆硬膜外阻滞的影响(systemic effects):;● Cardiovascular manifestations:;●Respiratory manifestations： ;●Visceral manifestations: 肠蠕动↑;硬膜外镇痛作用产生的机制;三、硬膜外阻滞的临床应用(The clinical applications of epidural block);(二) 常用局部麻醉药物(Commonly used spinal anesthetic agents) ;（三）注意事项;◆注药方式: ●