神经系统的解剖与评估-课件.pptVIP

OBJECTIVES After completion of this session the students should be able : To learn a basic Nervous System Examination To differentiate between “normal” and “abnormal” To apply findings to common clinical presentations To document findings in a structured, systematic way Outlines Introduction Review of anatomy and physiology Nursing assessment Introduction A complete neurological assessment consists of five steps: o Mental status exam o Cranial nerve assessment o Reflex testing o Motor system assessment o Sensory system assessment. A simple means of gathering a great deal of information about the patients neurological system is to observe the patient walking, talking, seeing, and hearing. Watching the patient enter the room is also important in giving the examiner information. Introduction The nervous system consists of the central nervous system (CNS), the peripheral nervous system, and the autonomic nervous system. Together these three components integrate all physical, emotional, and intellectual activities. The CNS includes the brain and spinal cord. These two structures collect and interpret voluntary and involuntary sensory and motor signals. A brief overview of the anatomy and physiology of the CNS is provided 一、解剖要点 （一）神经系统分类 1.中枢神经系统包括 脑和脊髓。 2.周围神经系统包括 脑神经和脊神经。 脑又分为： 大脑、间脑 脑干、小脑 脑干包括： 中脑、脑桥 延髓 内囊 1.内囊区：包括壳核、内囊、丘脑。 2.内囊的神经纤维：影响大脑病灶对侧身体。 神经兴奋的传导 神经元之间在结构上无连接， 而是依靠突触来传递信息。 脑血管 1.大脑中动脉 与颈内动脉相通，并直 角发出较细的豆纹动脉供应内囊区血液。 脑脊液 脑脊液是无色透明的液体，形成脑的水垫起保护作用，以免震动时脑组织与颅骨直接接触 脑脊液相当于脑与脊髓的组织液与淋巴液，有营养脑和脊髓的作用，并运走代谢产物 正常脑脊液具有一定的压力，对维持颅内压的相对稳定有重要作用。脑脊液中的化学物质还能起缓冲作用。成人脑脊液约100~140m 脑脊液充满于蛛网膜下腔脑室和脊髓中央管内 脑脊液循环 1.脑和脊髓的蛛网膜下腔内的脑脊液相通。 2.通过蛛网膜颗粒将蛛网膜下腔内的脑脊液渗入硬脑膜窦内，流入颈内静脉。 脑脊液主要自侧脑室和第三、四脑室脉络丛产生。再向下流入中脑水管和第四脑室，经过三个孔流入蛛网膜下腔，再由蛛网膜颗粒汇入硬脑膜静脉窦，最后经颈内静脉返回心脏 Neurological Assessment ?.?Introduction ?.?Vital Signs ?.?Mental Status ?.?Sensory Function ?.?Motor Function ?.?Level of Consciousness A) History Takin