局部麻醉药对脊的神经损害作用分析.pptVIP

局部肺醉药 对脊神经损害作用的分析 中山大学附属第一院 黄文超  BMJ2000321:1-12 Meta-analgsis141研究9559例病人 全髋置换(THR) 全膝置换(TKR) 髋关节骨折手术〔HFS) 明确证实 局部醉的临床效益优于全身醉 13病人有心肌梗死的病史, 但术后呼吸衰竭发生率下降59% Rodger a. et al  Anesthesiology 1994: 18: A1202 局部麻醉和麻醉监测的费用 均明显低于全身麻醉 Greenberg CP, et al.  e 2001 American Society cf Ansshesdoziss. Inc, Lippixont williams wilkins Influence of Obesity on Surgical Regional Anesthesia in lbe Ambulatory Setiing: Ant Analysis of 9, 038 Block Karen C. Nielsen, M.D., Unch GuNer, M.D., M H.S., t Susan M. Steele, M.D.,+ Stephen M. Klein, M.D. Roy A. Greengrass, M D, F.R.C.P., 5 Ricardo Pjetrobon, M.D., Ph D Conclusions: The present investigation shows that obesity is associated with higher block failure and complication rates in surgical regional anesthesia in the ambulatory setting Nonethe. less, the rate of successful blocks and overall satis faction re. mained high in patients with increased BML. Therefore,over- weight and obese patients should not be excluded from regional anesthesia procedures in the ambulatory setting.  痲醉医生对局部痲醉的考虑 Reg Anesth Pain Med 1998; 241-246 麻醉准备时间较长 术中神经阻滞不全 部分麻醉医生缺乏局麻的经验 局部麻醉药的脊神经影响 Hadzic A. et al.  脊神经损伤原因及发生率 局部麻醉药对脊神经的毒性  多个案例 妇科手术后出现下肢瘫痪或 长时间神经损害 麻醉方法多见于腰麻或腰硬联合麻醉 经常听到或会诊-这些案例  脊神经损伤原因及发生率 局部麻醉药对脊神经的毒性  脊神经损害原因 1.直接创伤 2.药物误入硬膜下腔或网膜下腔 3.局麻药物引起的神经症状 4硬膜外血肿 5脑膜炎各硬膜外脓少  developed an epidural haematoma following a combined spinal-epidural anaesthetic. Although the authors describe the commonly quoted incidence of spinal haematoma following epidural and spinal anaesthesia between I in 150 000 and I in 220 000. the true incidence is unknown Tam NL, Pac-Soo C, Pretorius PM. Epidural haematoma after a combined spinal-epidural anaesthetic in a patient treated with clopidogrel and dalteparin. Br J Anaesth 2006: 96: 262-5