超声在气道管理中的应用PPT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 Siddiqui N, Arzola C, Friedman Z, et al. Anesthesiology.2015 Nov;123(5):1033-41.? 定位环甲膜 Ultrasound Improves Cricothyrotomy Success in Cadavers with Poorly Defined Neck Anatomy Ultrasound guidance significantly decreased the incidence of injuries to the larynx and trachea Increased the probability of correct insertion by 5.6 times in cadavers with difficult and impossible landmark palpation. 外侧 甲状软骨 声带 声带 环甲膜 外侧 超声影像——甲状软骨、环甲膜 外侧 越尖峰，缺口伪影环甲膜 甲状软骨 声带 声带 伪影 超声影像 环状软骨 外侧 气管软骨 甲状腺峡部 外侧 气管软骨 外侧 Ultrasound-guided superior laryngeal nerve block and translaryngeal block for awake tracheal intubation in a patient with laryngeal abscess Iida T,Suzuki A, Kunisawa T,et al. J Anesth (2013) 27:309–310 临床应用1—清醒插管 Sonographically Guided S