椎管内麻醉-Intrathecal-Anesthesia.ppt

椎管内麻醉Neuraxial Anesthesia 夏 瑞 Introduction——Correlated Anatomy 三条韧带(由外到内) 棘上韧带 supraspinous ligament 棘间韧带 interspinous ligament 黄韧带 ligamentum flavum (yellow ligament) Correlated Anatomy 脊髓由脊膜所包裹 脊膜(由内至外)分为： 软膜 pia mater 蛛网膜 arachnoid mater 硬脊膜 dura mater 两层：内膜、外膜 硬膜外腔 epidural space 硬脊膜内、外层之间的区域 蛛网膜下腔subarachnoid space 软膜和蛛网膜之间的区域 Correlated Anatomy 第一节 蛛 网 膜 下 腔 阻 滞（脊麻) Section one Subarachnoid block (spinal anesthesia) 定义（definition） The agent is injected into the CSF(cerebrospinal fluid) in the subarachnoid space of the meninges (the three-layered covering of the spinal cord) using a lumbar interspace in the vertebral column. 局麻药 脑脊液 脊神经、背根神经节及脊髓表面 第一节 蛛 网 膜 下 腔 阻 滞 Section one Subarachnoid block (spinal anesthesia) 比重：According to the differences of gravity between the local anesthetic and CSF Hyperbaric solution: It is heavier than CSF,and it can be made (重比重) by the addition of glucose. Hypobaric solution: It is lighter than CSF,and it can be made (轻比重) 　 by the addition of sterile water. Isobaric solution: It is nearly equal to gravity of CSF, and it is (等比重) mixed with CSF(at least 1:1). (The gravity of CSF is 1.003～1.009) 平面：According to the level of neural blockade Spinal anesthesia Indirect actions(systemic effects)  ★ Pulmonary manifestations（呼吸系统影响） Tidal volume remains unchanged during high spinal anesthesia, and vital capacity decreases a small amount from 4.05 to 3.73?L 潮气量改变不明显,肺活量少量下降 The rare respiratory arrest associated with spinal anesthesia is also unrelated to phrenic or inspiratory dysfunction but rather to hypoperfusion of the respiratory centers in the brainstem 呼吸暂停与脑干呼吸中枢血流灌注不足有关，与呼吸肌功能无关 ★ Gastrointestinal manifestations(胃肠道影响） Spinal block sympathetic block vagal t