超声在麻醉和疼痛医学中的应用(final).ppt

上海交通大学附属第六人民医院麻醉科 　 W. Jiang ;麻醉与超声 Anaesthesia and ultrasound;内 容 Contents ; ; ;　; 超声引导局部麻醉 Ultrasound-guided regional anesthesia (UGRA);超声引导的外周神经阻滞优点 Advantages of Ultrasound Guided Peripheral Nerve Blocks;Ultrasound-guided Regional Anesthesia. Anesthesiology 2006; 104:368–73. ;Ultrasound-guided Regional Anesthesia. Anesthesiology 2006; 104:368–73. ;平面内和平面外 in plane and out of plane;超声下肌间沟臂丛阻滞ultrasound guided interscalene brachial plexus block;液性暗区; ; ;Ultrasound Imaging of the Thoracic Epidural Space. Regional Anesthesia and Pain Medicine,2002, 27(2): pp 200–206;Ultrasound Imaging of the Thoracic Epidural Space. Regional Anesthesia and Pain Medicine,2002, 27(2): pp 200–206;Ultrasound Imaging of the Thoracic Epidural Space. Regional Anesthesia and Pain Medicine,2002, 27(2): pp 200–206;Caudal injection can be reliably imaged using portable ultrasound – a preliminary study. Pediatric Anesthesia, 2005, 15: 948–952;Real-time three-dimensional ultrasound for continuous interscalene brachial plexus blockade. J Anesth (2009) 23:466–468;Case 1;Case 1;一般情况 患者：男，86岁, 39kg 病史 冠心病，前间壁心梗史5年 高血压病史18年 脑梗史10年血肌酐升高史5年,肾性贫血； 骨质疏松史5年 诊断 双下肢动脉粥样硬化性闭塞症 右第二足趾截趾术后，右第三足趾坏死并感染右足跟软组织缺损 拟行手术：右大腿截肢术 高龄，高危！ ;一般情况 患者：男，68岁， 病史 重度鼾症，BMI ≈40 kg/m2 慢性心衰 拟行手术：右膝关节置换术 麻醉方法 术前：神经阻滞 (股神经+坐骨神经 +股外侧皮神经+闭孔神经 术中 喉罩浅麻醉维持 术后 患者清醒迅速，无痛 避免了鼾症病人术后拔管延迟，呼吸抑制等并发症;无痛关节置换 no pains for Joint Replacement ;超声与疼痛 ultrasound and pain management;疼痛治疗-神经阻滞 pain management-nerve block ;超声与疼痛 ultrasound and pain management;超声与疼痛 ultrasound and pain management;超声与疼痛 ultrasound and pain management;小关节源性疼痛 pain of facet Joint in the Lumbar Spine;Ultrasound Guidance for Facet Joint Injections in the Lumbar Spine: A computed tomography-Controlled feasibility Study. Anesth Analg 2005;101:579–83.;食道超声心动图 Transesophageal echocardiography (TEE) ;食道超声心动图 Transesophageal echocardiography (TEE) ;Real-Time 3-Dimensional Echocardiography in the Operating Room. Semin Cardiothorac Vasc Anesth. 2008, 12