超声和神经刺激仪双重引导课件.pptxVIP

超声和神经刺激仪双重引导锁骨上臂丛神经阻滞佛山市中医院刘晓捷 医学硕士（特别鸣谢 罗富荣博士）三甲中医院佛山市创伤急救中心病床2400多张年手术3.5万台骨伤科15个病区国家中医药管理局的重点专科病床1000张年手术2万多台问题一：为什么神经阻滞？神经阻滞的优势骨科术前移动改变体位时的镇痛不受术后使用抗凝剂的限制充分控制疼痛以便及早活动全身影响小镇痛时间长罗富荣博士于2010年德国进修学习本人于2012年北京积水潭医院进修学习问题二：为什么要双重引导？神经阻滞的定位技术神经刺激仪：电生理定位，较精确，深浅皆宜，但同一神经多点注射有顾虑。超声成像仪：影像学定位，浅部好于深部，可同一神经多点注射，减少用药。减少邻近组织结构损伤。N问题三：如何选择不同入路？高士濂，实用解剖图谱Mehrkens, Peripheral regional anaesthesiaPronation of the forearmAnd elbowSupination of the forearm Ulnar inclination and flexion of the wristFlexion of 4th and 5th fingers臂丛阻滞头端根、干膈神经气胸束深在尾端神经分散肌间沟锁骨上锁骨下腋路臂丛阻滞肌间沟：C5、6、7或上干、中干支配区，尤其肩部和上臂的手术，但尺神经失败率高。N臂丛阻滞集中，所以效率高锁骨上：臂丛神经最为集中，除肩部手术外上肢手术。但气胸风险大。N臂丛阻滞锁骨下：除肩部手术外上肢手术。N臂丛阻滞腋路：除肩部手术外上肢手术。N问题四：局麻药的选择？Ropivacaine: a review of its use in regional Anaesthesia and acute pain management. Thus ropivacaine, with its efficacy, lower propensity for motor block and reduced potential for CNS toxicity and cardiotoxicity, appears to be an important option for regional anaesthesia and for the management of postoperative and labour pain. file:///C:\Documents%20and%20Settings\Administrator\桌面\学习班\Ropivacaine%20AND%20Bupivacaine%20AND%20toxicity%20AND%20peripheral%20nerve%20block%20-%20PubMed%20-%20NCBI.htmDrugs. 2005;65(18):2675-717.Some current controversies in paediatric regional anaesthesia Conversely, continuous infusion of ropivacaine offers the safest therapy. file:///C:\Documents%20and%20Settings\Administrator\桌面\学习班\Ropivacaine%20AND%20Bupivacaine%20AND%20toxicity%20AND%20peripheral%20nerve%20block%20-%20PubMed%20-%20NCBI.htmCurrfile:///C:\Documents%20and%20Settings\Administrator\桌面\学习班\Ropivacaine%20AND%20Bupivacaine%20AND%20toxicity%20AND%20peripheral%20nerve%20block%20-%20PubMed%20-%20NCBI.htm file:///C:\Documents%20and%20Settings\Administrator\桌面\学习班\Ropivacaine%20AND%20Bupivacaine%20AND%20toxicity%20AND%20peripheral%20nerve%20block%20-%20PubMed%20-%20NCBI.htmOpinfile:///C:\Documents%20and%20Settings\Administrator\桌面\学习班\Ropivacaine%20AND%20Bupivacaine%20AND%20toxicity%20AND