麻醉相关资料：神经阻滞定位方法进展.pdf

神经阻滞定位方法进展
Advance in Locatlizaion of Nerve
Block
杭燕南
Yannan Hang M .D.
Departmen t of An esthesiology
Ren Ji Hospital
Shangh ai Second Medical University
Shanghai 2 00001
外周神经阻滞的优点
Advantage of peripheral nerve block
阻滞成功率高 High essful 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 ed by patients
费用低 Low cost
内容提要 Contents

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 low er 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
(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
anatom y landm arks, it’s difficult to
operate in clinic
(二)异感定位
Sensory location
n 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 an esthetic effects w ith sensory location
神经分布与病人状态,可能无法引出异感
Sensation may b e not foun d in som e patien ts
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 essful 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***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 ex pensive equipment
超声的基本原理
Basic principles of Ultrasound
~20MHz
Clinical ultrasound with ~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 rability; vice ver sa
浅表神经可用>10MHz,而深部神经需用<,超声
定位深部神经应与局部解剖学相结合
>10MHz frequency used in superficial nerves a