神经阻滞定位方法进展.ppt

神经阻滞定位方法进展AdvanceinLocatlizaionofNerveBlock

阻滞成功率高Highsuccessfulratio安全性高Moresafety应激反应轻Lessstressresponse降低深静脉血栓形成AvoidDVT恢复快Fastrecovery生理机能稳定stablephysicalstatus病人欢迎Welcomedbypatients费用低Lowcost外周神经阻滞的优点 Advantageofperipheralnerveblock

1.神经阻滞定位方法Localizationmethodsofnerveblock2.神经刺激器与神经刺激针Nervestimulatorandneedles3.下肢神经阻滞在老年重危病人中的应用Applicationoflowerextremitynerveblockinelderlyseverepatients内容提要Contents

解剖定位Anatomylocation异感定位Sensorylocation超声和放射学定位Ultrasoundand一、神经阻滞的定位方法 I.Locationmethodsofnerveblock

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。Variationanddecentralizationofnerves,irregulardistribution,ambiguityofanatomylandmarks,it’sdifficulttooperateinclinic Anatomylocation（一）解剖定位

n是否需要寻找异感尚有争议Debateoffindingspecialsensory找到“异感”，麻醉效果并非一定完善Unsatisfiedanestheticeffectswithsensorylocation神经分布与病人状态，可能无法引出异感Sensationmaybenotfoundinsomepatients寻找异感可能损伤神经Maybedamagenerves（二）异感定位 Sensorylocation

（三）超声和放射学定位 Ultrasoundandradiologicallocation优点Advantages提高神经阻滞的成功率Increasethesuccessfulrateofnerveblock观察局麻药注射后的扩散规律Observethedistributionoflocalanesthetics避免血管内注射的发生Avoidintravascularinjection减少麻醉药用量Reducethedosageofanesthetics

需要特殊设备和人员技术培训Needequipmentsandtraining增加了操作步骤Moreoperationsteps仪器体积较大，价格昂贵Largesizeandexpensiveequipment缺点Disadvantages

临床应用的超声频率为2.5~20MHzClinicalultrasoundwith2.5~20MHz频率越高空间分辨率越好，但穿透性越差；反之亦然Higherfrequencywithbetterspacedifferentiationratiobutlesspenetrability;viceversa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10MHzfrequencyusedinsuperficialnervesand＜7.5MHzindeepones,ultrasoundshouldbeusedwithtopographyespeciallyindeepnerveblock BasicprinciplesofUltrasound超声的基本原理

超声引导下神经阻滞Nerveblockguidedbyultrasound

1、Mid-axisobliquesurfaceofinterscalenegroove2、Supra-claviclecoronalobliquesurface3、Sub-claviclesagittalsurface4、tra