临床医学神经系统的解剖与评估.pptxVIP

神经系统的解剖与健康评估ANATOMICAL STRUCTURE And NURSING ASSESSMENT OF THE NERVOUS SYSTEM 广医二院 于红静OBJECTIVESAfter completion of this session the students should be able : To learn a basic Nervous System ExaminationTo differentiate between “normal” and “abnormal”To apply findings to common clinical presentationsTo document findings in a structured, systematic wayOutlines Introduction Review of anatomy and physiologyNursing assessment Introduction A complete neurological assessment consists of five steps: o Mental status exam o Cranial nerve assessment o Reflex testing o Motor system assessment o Sensory system assessment. A simple means of gathering a great deal of information about the patient's neurological system is to observe the patient walking, talking, seeing, and hearing. Watching the patient enter the room is also important in giving the examiner information. IntroductionThe nervous system consists of the central nervous system (CNS), the peripheral nervous system, and the autonomic nervous system. Together these three components integrate all physical, emotional, and intellectual activities. The CNS includes the brain and spinal cord. These two structures collect and interpret voluntary and involuntary sensory and motor signals. A brief overview of the anatomy and physiology of the CNS is provided 神经系统的功能: 1、控制和调节其它系统的活动，使人体成为一个有机的整体2、维持机体与外环境间的统一3、人类神经系统不仅适应环境，还能主观改造世界（主导系统）一、解剖要点（一）神经系统分类 1.中枢神经系统包括 脑和脊髓。2.周围神经系统包括 脑神经和脊神经。 一、神经系统的区分 中枢神经系统包括脑和脊髓 含有绝大多数神经元的胞体。 周围神经系统包括12对脑神经、31对脊神经 、内脏神经主要由感觉神经元和运动神经元的轴突组成。 内脏神经 交感神经 副交感神经 神经按分布及性质又分为： 躯体神经 内脏神经 感觉（传入）神经 运动（传出）神经组成：脑位于颅腔内。脊髓位于椎管内。脊髓一、位置和外形位置：椎管内外形：前后略扁的圆柱形。上端在枕骨大孔处与延脑相连，成人脊髓下端平对第1腰椎体下缘，全长45cm；新生儿下端平对第3腰椎体。 颈膨大：C4-T1腰骶膨大：T12-S3脊髓圆锥：腰骶膨大向下急剧缩小的一个圆锥形末端。终丝：脊髓圆锥向下延为一根细长的无神经组织的丝，止于尾骨背面的骨膜。 脊髓节段与椎骨的对应关系脊髓节段：每对脊神经根的根丝相连的一段脊髓称为一个脊髓节段。共31个节段：C 8节、T 12节、L 5节、S 5节、CO 1节。马尾：腰、骶、尾神经根在椎管内几乎垂直下行，围绕终丝周围形成马尾状结构称之。 临床腰椎穿刺部位： 第3、4腰椎间或第4、5腰椎间穿刺脊髓节段与椎骨的对应关系（成人）：C1-4节段：C1-4椎体C5-8、T1-4节段：-1椎体T5-8节段：-2椎体T9-12节段：-3椎体L1-5节段：10-12胸椎体S1-