超聲引導(dǎo)下豎脊肌阻滯在臨床應(yīng)用

超聲引導(dǎo)下豎脊肌平面阻滯臨床應(yīng)用首都醫(yī)科大學(xué)從屬北京朝陽醫(yī)院

麻醉科

馬丹旭-8-12超聲引導(dǎo)下豎脊肌阻滯在臨床應(yīng)用第1頁內(nèi)容一、筋膜和筋膜平面阻滯概況二、豎脊肌平面阻滯在胸科手術(shù)應(yīng)用

三、豎脊肌平面阻滯在腹部手術(shù)應(yīng)用

四、豎脊肌平面阻滯在脊柱手術(shù)應(yīng)用超聲引導(dǎo)下豎脊肌阻滯在臨床應(yīng)用第2頁筋膜平面阻滯

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blockQuadratus

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blockSerratus

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abdominis

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block:

plane

and

simple.El-Boghdadly

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Anaesthesia.Apr;72(4):434-438.超聲引導(dǎo)下豎脊肌阻滯在臨床應(yīng)用第3頁“詭異筋膜”麻醉為筋膜平面阻滯提供空間疼痛人體生物力學(xué)調(diào)控超聲引導(dǎo)下豎脊肌阻滯在臨床應(yīng)用第4頁胸腰筋膜麻醉腰方肌阻滯豎脊肌平面阻滯胸腰筋膜平面阻滯疼痛調(diào)整腰臀部和脊柱相關(guān)軟組織張力肌筋膜炎（急性腰肌扭傷）神經(jīng)病理性疼痛超聲引導(dǎo)下豎脊肌阻滯在臨床應(yīng)用第5頁超聲引導(dǎo)下豎脊肌平面阻滯在胸科手術(shù)臨床應(yīng)用超聲引導(dǎo)下豎脊肌阻滯在臨床應(yīng)用第6頁超聲引導(dǎo)下豎脊肌平面阻滯Forero

M,

AdhikarySD,

Lopez

H,

etal.

The

Erector

SpinaePlaneBlock:

A

Novel

AnalgesicTechnique

inThoracicNeuropathic

Pain.Reg

Anesth

PainMed.

2016,41(5):621-627.超聲引導(dǎo)下豎脊肌阻滯在臨床應(yīng)用第7頁T5橫突豎脊肌平面阻滯范圍超聲引導(dǎo)下豎脊肌阻滯在臨床應(yīng)用第8頁T5橫突豎脊肌平面

阻滯范圍驗(yàn)證豎脊肌平面阻滯有效性和安全性——隨機(jī)對照研究超聲引導(dǎo)下豎脊肌阻滯在臨床應(yīng)用第9頁連續(xù)豎脊肌平面阻滯首次劑量

25ml

0.5%羅哌卡因；鎮(zhèn)痛泵

8ml/h0.2%羅哌卡因，bolus

5ml

，鎖定60min超聲引導(dǎo)下豎脊肌阻滯在臨床應(yīng)用第10頁超聲引導(dǎo)下豎脊肌平面阻滯在腹部手術(shù)臨床應(yīng)用超聲引導(dǎo)下豎脊肌阻滯在臨床應(yīng)用第11頁雙側(cè)T7豎脊肌平面阻滯用于腹壁疝手術(shù)鎮(zhèn)痛雙側(cè)T7豎脊肌平面阻滯用于減肥手術(shù)鎮(zhèn)痛雙側(cè)T8連續(xù)豎脊肌平面阻滯用于膀胱前列腺切除術(shù)超聲引導(dǎo)下豎脊肌阻滯在臨床應(yīng)用第12頁術(shù)后第1天 術(shù)后第2天 術(shù)后第4天每側(cè)首次劑量：3ml2%利多卡因，10ml

0.25%布比卡因；置管，鎮(zhèn)痛泵6ml/h

0.1%布比卡因；手術(shù)結(jié)束前10ml

0.25%布比卡因超聲引導(dǎo)下豎脊肌阻滯在臨床應(yīng)用第13頁豎脊肌平面阻滯原理Boezaart,

A.P.

Atlas

of

PeripheralNerve

blocksandAnatomyfor

Orthopaedic

Anesthesia.

2008Forero

M,

AdhikarySD,

Lopez

H,

etal.

The

Erector

SpinaePlaneBlock:

ANovel

AnalgesicTechnique

in

ThoracicNeuropathic

Pain.Reg

Anesth

PainMed.

2016,41(5):621-627.超聲引導(dǎo)下豎脊肌阻滯在臨床應(yīng)用第14頁豎脊肌平面阻滯解剖示意圖Chin

KJ,

Malhas

L,

Perlas

A.

TheErector

SpinaePlane

Block

ProvidesVisceral

Abdominal

AnalgesiainBariatric

Surgery:

AReport

of

3Cases.

Reg

Anesth

PainMed.

2017超聲引導(dǎo)下豎脊肌阻滯在臨床應(yīng)用第15頁豎脊肌平面阻滯與后椎板阻滯Pfeiffer

G1,

Oppitz

N,

Sch?ne

S,

et

al.Analgesia

ofthe

axilla

using

a

paravertebralcatheter

inthelamina

technique.

Anaesthesist.

Apr;55(4):423-7.Jüttner

T1,Werdehausen

R,

Hermanns

H,

etal.

The

paravertebral

lamina

technique:a

new

regional

anesthesia

approach

for

breast

surgery.

JClin

Anesth.

Sep;23(6):443-50.超聲引導(dǎo)下豎脊肌阻滯在臨床應(yīng)用第16頁超聲引導(dǎo)下豎脊肌平面阻滯在脊柱手術(shù)臨床應(yīng)用超聲引導(dǎo)下豎脊肌阻滯在臨床應(yīng)用第17頁CorrespondenceClinical

experiences

of

ultrasound-

guided

erector

spinae

plane

block

for

thoracic

vertebra

surgeryContents

lists

available

at

ScienceDirect)ournal

of

Clinical

Anesthesiab?anzhtnt?rnaRhomBoid

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FfHJSEl9超聲引導(dǎo)下豎脊肌阻滯在臨床應(yīng)用第18頁總結(jié)?

胸腰筋膜在麻醉/疼痛領(lǐng)域有遼闊研究空間?