神经阻滞定位方法进展.pdfVIP

神经阻滞定位方法进展 Advance in Locatlizaionof Nerve Block 杭燕南 Yannan Hang M.D. Department of Anesthesiology RenJi Hospital Shanghai Second Medical University Shanghai200001 外周神经阻滞的优点 Advantageof peripheral nerve block 阻滞成功率高 High successful ratio 安全性高 More safety 应激反应轻 Less stress response 降低深静脉血栓形成 Avoid DVT 恢复快 Fast recovery 生理机能稳定 stable physical status 病人欢迎 Welcomed by patients 费用低 Low cost 内容提要Contents 1.神经阻滞定位方法 Localization methods of nerve block 2.神经刺激器与神经刺激针 Nervestimulator and needles 3.下肢神经阻滞在老年重危病人中的应用 Applicationof lower extremity nerve block in elderly severe patients 一、神经阻滞的定位方法 I.Locationmethodsof nerve block 解剖定位Anatomy location 异感定位Sensory location 超声和放射学定位 Ultrasound and （一）解剖定位 Anatomy location 神经解剖变异，神经分布不规则，神经不 是集中某个单一的点，解剖标记不明确或 不易辨认，因此，临床操作难度较大。 Variation and decentralization of nerves, irregulardistribution,ambiguity of anatomy landmarks, it’s difficult to operate inclinic （二）异感定位 Sensory location n 是否需要寻找异感尚有争议 Debate of finding specialsensory 找到“异感”，麻醉效果并非一定完善 Unsatisfied anesthetic effects with sensory location 神经分布与病人状态，可能无法引出异感 Sensation may be not found in some patients 寻找异感可能损伤神经 Maybe damage nerves （三）超声和放射学定位 Ultrasound and radiological location 优点Advantages 提高神经阻滞的成功率 Increasethe successful rate of nerve block 观察局麻药注射后的扩散规律 Observethe distribution of local anesthetics 避免血管内注射的发生 Avoid intravascularinjection 减少麻醉药用量 Reduce the dosage ofanesthetics 缺点Disadvantages 需要特殊设备和人员技术培训 Need equipments andtraining 增加了操作步骤 More operation steps 仪器体积较大，价格昂贵 Largesize