超声在气道管理中的应用医学幻灯片教材教学课件.ppt

上海市第六人民医院 Shanghai Sixth People’s Hospital 上海市第六人民医院 Shanghai Sixth People’s Hospital 上海市第六人民医院 Shanghai Sixth People’s Hospital 上海市第六人民医院 Shanghai Sixth People’s Hospital 上海市第六人民医院 Shanghai Sixth People’s Hospital 上海市第六人民医院 Shanghai Sixth People’s Hospital 上 海 交 通 大 学 附 属 第 六 人 民 医 院 麻 醉 科 赵达强 　 超声在气道管理中的应用 2016-5-27 颈部气道解剖 定位喉上神经 The thyrohyoid membrane as a target for ultrasonography-guided block of the internal branch of the superior laryngeal nerve Stopar-Pintaric T, Vlassakov K, Azman J. J Clin Anesth.2015 Nov ; 27(7): 548-52. In conclusion, we are proposing an anatomical concept for a new, simpler, consistently reproducible US-guided iSLN block technique using the thyrohyoid membrane to define the target plane for low-volume local anesthetic injection. 外侧 舌骨 外侧 舌骨 超声影像——舌骨、喉上神经 外侧 过拱桥，甲舌膜里寻喉上 定位环甲膜 The conventional method, inspection and palpation, has a low success rate, especially in women (24–35%). Elliott DS, Baker PA, Scott MR, et al. Accuracy of surface landmark identification for cannula cricothyroidotomy.Anaesthesia 2010; 65: 889–94 Lamb A, Zhang J, Hung O, et al. Accuracy of identifying the cricothyroid membrane by anesthesia trainees and staff in a Canadian institution. Can J Anaesth 2015; 62: 495–503 Barbe N,Martin P,Pascal J,et al. Ann Fr Anesth Reanim.2014 Mar;33(3):163-6. 定位环甲膜 Locating the cricothyroid membrane in learning phase: Value of ultrasonography ? The CTM was accurately identified by palpation and ultrasound by 46% and 100% of residents respectively (P 0.05). Kristensen MS, Teoh WH, Rudolph SS,et al. Br J Anaesth. 2015 Jun;114(6):1003-4.? 定位环甲膜 Structured approach to ultrasound-guided identification of the cricothyroid membrane: a randomized comparison with the palpation method in the morbidly obese When using the conventional digital palpation method, 13 of 35 anaesthetists (37%) were able to locate the cricothyroid membrane successfully within 2 min, whereas the success rate was 29 of 35 (83%) when the structured stepwis