神经阻滞北京协和论坛.pptxVIP

外周神经阻滞的优点Advantage of 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 Nerve stimulator and needles 3. 下肢神经阻滞在老年重危病人中的应用 Application of lower extremity nerve block in elderly severe patients一、神经阻滞的定位方法 I. Location methods of nerve block解剖定位 Anatomy location异感定位 Sensory location 超声和放射学定位 Ultrasound and radiological神经刺激器定位 Nerve stimulator location（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, irregular distribution, ambiguity of anatomy landmarks, it’s difficult to operate in clinic（二）异感定位Sensory location是否需要寻找异感尚有争议Debate of finding special sensory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Increase the successful rate of nerve block观察局麻药注射后的扩散规律Observe the distribution of local anesthetics避免血管内注射的发生Avoid intravascular injection减少麻醉药用量Reduce the dosage of anesthetics缺点 Disadvantages需要特殊设备和人员技术培训Need equipments and training增加了操作步骤More operation steps仪器体积较大，价格昂贵Large size and expensive equipment超声的基本原理Basic principles of Ultrasound临床应用的超声频率为2.5~20MHzClinical ultrasound with 2.5~20MHz频率越高空间分辨率越好，但穿透性越差；反之亦然Higher frequency with better space differentiation ratio but less penetrability; vice versa浅表神经可用＞10MHz，而深部神经需用＜7.5MHz，超声定位深部神经应与局部解剖学相结合＞10MHz frequency used in superficial nerves and ＜7.5MHz in deep ones, ultrasound should be used with topography especially in deep nerve block超声引导下神经阻滞Nerve block guided by ultrasound超声探头的位置 Location of ultrasound probe1、肌间沟中轴斜面2、锁骨上冠状斜面3、锁骨下矢状面　4、腋部横断面5、肱骨中部横断面1、Mid-axis oblique surface of interscalene groove2、Supra-clavicle coronal oblique surface3、Sub-c