超聲引導(dǎo)上肢神經(jīng)阻滯培訓(xùn)課件

1、趙達(dá)強(qiáng)超聲引導(dǎo)上肢神經(jīng)阻滯趙達(dá)強(qiáng)超聲引導(dǎo)上肢神經(jīng)阻滯上海市第六人民醫(yī)院Shanghai Sixth Peoples Hospital上海市第六人民醫(yī)院上海市第六人民醫(yī)院Shanghai Sixth Peoples Hospital上肢的神經(jīng)支配上海市第六人民醫(yī)院上肢的神經(jīng)支配上海市第六人民醫(yī)院Shanghai Sixth Peoples Hospital病例一：橈骨遠(yuǎn)端骨折內(nèi)固定手術(shù)上海市第六人民醫(yī)院病例一：橈骨遠(yuǎn)端骨折內(nèi)固定手術(shù)上海市第六人民醫(yī)院Shanghai Sixth Peoples Hospital神經(jīng)阻滯入路選擇適應(yīng)癥肩部、鎖骨、 上臂近端手術(shù) 臂叢神經(jīng)置管肱骨中段 以下上肢肘部以

2、下 臂叢神經(jīng)置管同鎖骨下入路缺點(diǎn)缺乏超聲引導(dǎo) 阻滯較難1. 受體位限制2. 需要單獨(dú)阻 滯肌皮神經(jīng)并發(fā)癥刺傷鎖骨下血管刺傷腋血管上海市第六人民醫(yī)院神經(jīng)阻滯入路選擇適應(yīng)癥肩部、鎖骨、 上臂近上海市第六人民醫(yī)院Shanghai Sixth Peoples Hospital上海市第六人民醫(yī)院上海市第六人民醫(yī)院Shanghai Sixth Peoples Hospital上海市第六人民醫(yī)院上海市第六人民醫(yī)院Shanghai Sixth Peoples Hospital上海市第六人民醫(yī)院上海市第六人民醫(yī)院Shanghai Sixth Peoples HospitalUrmey WF, Talts KH,

3、 Sharrock NE. One hundred percent incidence of hemidiaphragmatic paresis associated with interscalene brachial plexus anesthesia as diagnosed by ultrasonography. Anesth Analg 1991; 72: 498-503.上海市第六人民醫(yī)院Urmey WF, Talts KH, S上海市第六人民醫(yī)院Shanghai Sixth Peoples Hospital膈神經(jīng)阻滯USVSNS上海市第六人民醫(yī)院膈神經(jīng)阻滯USVSNS上海市第六人

4、民醫(yī)院Shanghai Sixth Peoples Hospital膈神經(jīng)阻滯5MLVS10ML上海市第六人民醫(yī)院膈神經(jīng)阻滯5MLVS10ML上海市第六人民醫(yī)院Shanghai Sixth Peoples Hospital膈神經(jīng)阻滯extrafascial injection上海市第六人民醫(yī)院膈神經(jīng)阻滯extrafascial in上海市第六人民醫(yī)院Shanghai Sixth Peoples Hospital鎖骨上上海市第六人民醫(yī)院鎖骨上上海市第六人民醫(yī)院Shanghai Sixth Peoples Hospital鎖骨下上海市第六人民醫(yī)院鎖骨下上海市第六人民醫(yī)院Shanghai Sixth

5、 Peoples Hospital腋路上海市第六人民醫(yī)院腋路上海市第六人民醫(yī)院Shanghai Sixth Peoples Hospital神經(jīng)阻滯的選擇肌間溝+腋路取長補(bǔ)短N(yùn)ervesGroup S (n=40)Group C (n=40)P valueAxillaryRadial Median UlnarMusculocutaneousMCNA MCNFAIntercostobrachial Total0/7/330/10/300.4120/6/340/8/320.5562/9/291/13/260.8789/18/130/12/280.0000/15/250/18/220.4968/21

6、/110/12/280.0039/19/120/10/300.01340/0/00/9/310.00068/95/1571/92/2270.000上海市第六人民醫(yī)院神經(jīng)阻滯的選擇肌間溝+腋路NervesGr上海市第六人民醫(yī)院Shanghai Sixth Peoples Hospital病例二上海市第六人民醫(yī)院病例二上海市第六人民醫(yī)院Shanghai Sixth Peoples Hospital麻醉遇到的問題上海市第六人民醫(yī)院麻醉遇到的問題上海市第六人民醫(yī)院Shanghai Sixth Peoples Hospital皮膚、肌肉、鎖骨的神經(jīng)支配上海市第六人民醫(yī)院皮膚、肌肉、鎖骨的神經(jīng)支配上海市第

7、六人民醫(yī)院Shanghai Sixth Peoples Hospital鎖骨上神經(jīng)胸內(nèi)側(cè)神經(jīng)胸外側(cè)神經(jīng)胸鎖乳突肌肌支鎖骨下神經(jīng)副神經(jīng)斜方肌支需要阻滯的神經(jīng)上海市第六人民醫(yī)院鎖骨上神經(jīng)需要阻滯的神經(jīng)上海市第六人民醫(yī)院Shanghai Sixth Peoples Hospital超聲引導(dǎo)鎖骨上神經(jīng)&臂叢阻滯1 前斜角肌2 中斜角肌3 后斜角肌4 胸鎖乳突肌5 頸外靜脈6 臂叢7 鎖骨上神經(jīng)上海市第六人民醫(yī)院超聲引導(dǎo)鎖骨上神經(jīng)&臂叢阻滯1 前斜角肌上海市第六人民醫(yī)院Shanghai Sixth Peoples Hospital病例三上海市第六人民醫(yī)院病例三上海市第六人民醫(yī)院Shanghai Sixt

8、h Peoples Hospital病例四上海市第六人民醫(yī)院病例四上海市第六人民醫(yī)院Shanghai Sixth Peoples HospitalDouble-crush雙重打擊Upton AR,McComas AJ.The double crush in nerve entrapment syndromes.Lancet. 1973 Aug 18;2(7825):359-62.Osterman AL. The double crush syndrome. Orthop Clin North Am.1988 Jan;19(1):147-55.0.William J,John C.The dou

9、ble crush syndrome. J Hand Surg Am. 2013 Apr;38(4):799-801.Kane PM, Daniels AH, Akelman E. Double crush syndrome. J Am Acad Orthop Surg. 2015 Sep;23(9):558-62.上海市第六人民醫(yī)院Double-crush雙重打擊Upto上海市第六人民醫(yī)院Shanghai Sixth Peoples Hospital手術(shù)部位皮膚神經(jīng)支配上海市第六人民醫(yī)院手術(shù)部位皮膚神經(jīng)支配上海市第六人民醫(yī)院Shanghai Sixth Peoples Hospital臂內(nèi)側(cè)皮神經(jīng)、 前臂內(nèi)側(cè)皮神經(jīng)阻滯上海市第六人民醫(yī)院臂內(nèi)側(cè)皮神經(jīng)、 前臂內(nèi)側(cè)皮神經(jīng)阻滯上海市第六人民醫(yī)院Shanghai Sixth Pe