病列研究医学PPT模板.ppt

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 心血管效应 2 呼吸抑制 3 马尾综合征 4 恶心呕吐 1 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 Page * Page * Page * Page * ** 蛛网膜下腔：前面解剖我们已经讲解过了 又叫腰麻或者脊麻 When Dr August Bier pioneered spinal anaesthesia in the 1890s he observed that his patients, all apparently pain-free during the procedure, suffered from vomiting and severe headaches for days afterwards. The German doctor, concerned about these complications, decided he must e