連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件

連續(xù)外周神經(jīng)阻滯在術(shù)后鎮(zhèn)痛中的應(yīng)用附屬第一醫(yī)院連續(xù)外周神經(jīng)阻滯在術(shù)后1神經(jīng)阻滯的概直接在末梢的神經(jīng)干、叢,腦脊神經(jīng)根、交感神經(jīng)節(jié)等神經(jīng)組織內(nèi)或附近注射藥物或給予物理刺激而阻斷神經(jīng)功能傳導(dǎo)稱為神經(jīng)阻滯化學(xué)性神經(jīng)阻滯療法主要采用局部麻醉藥物阻斷神經(jīng)傳導(dǎo)功能,可用于手術(shù)中鎮(zhèn)痛,而更多的是用于疼痛治療。使用高濃度的局麻藥或神經(jīng)破壞藥物進(jìn)行神經(jīng)阻滯,可長時(shí)間甚至永久性地(不可逆性的)阻斷神經(jīng)傳導(dǎo)功能,被稱為神經(jīng)破壞性阻滯神經(jīng)阻滯的概2神經(jīng)阻滯治療疼痛的特點(diǎn)在最短的時(shí)間內(nèi)、以最快的速度將最合理的藥物、準(zhǔn)確地注射到最需要的病變部位?！鲦?zhèn)痛效果確實(shí)可靠。對疾病的診斷具有重要意義。■治療范圍及時(shí)效可選擇性強(qiáng)。副作用小■操作簡便易學(xué)神經(jīng)阻滯治療疼痛的特點(diǎn)3大腦皮中央后回痛覺傳導(dǎo)通路疼痛是機(jī)體對傷害性丘腦刺激的感覺釋義。傷害性刺激是沿著周圍神經(jīng)①、②和③分別傳導(dǎo)至中樞神經(jīng)系統(tǒng),來一級第二級和第三級神并在此產(chǎn)生反應(yīng)以保護(hù)機(jī)體免遭傷害。受大腦皮4手術(shù)疼痛及其應(yīng)激反應(yīng)的處理一焦慮下丘腦下丘腦阿片類藥饑餓熱丟失激素←合成分解激素的調(diào)控酸中毒缺氧冬痛緩解藥傳入刺激(疼痛)神經(jīng)元阻斷局部組織因子(疼痛因子調(diào)節(jié)、給予手術(shù)疼痛及其應(yīng)激反應(yīng)的處理5傳入迷走神經(jīng)未阻滯神經(jīng)阻滯←膈傳人迷走神經(jīng)未阻滯不能完全答/)+傳入交感神經(jīng)阻滯不全抑制手術(shù)|○應(yīng)激反應(yīng)傳人軀體神經(jīng)阻滯不全的原因一骨盆傳入神經(jīng)未阻滯潛在的體液釋放機(jī)制熱丟失(顫抖)神經(jīng)阻滯不能完全抑制手術(shù)應(yīng)急反應(yīng)的因素傳入迷走神經(jīng)未阻滯6抑制手術(shù)應(yīng)激反應(yīng)的措施全身阿片類藥a2激動(dòng)劑外周神經(jīng)阻滯冷卻鎮(zhèn)痛蛛網(wǎng)膜下腔阻滯硬膜外阻滯阿片類藥(硬膜外蛛網(wǎng)膜下腔)生長激素釋放抑制因子電刺激(TENS)抗組胺藥,糖皮質(zhì)激素氯胺酮環(huán)氧酶抑制劑,局麻藥P物質(zhì)拮抗劑,阿片類藥抑制手術(shù)應(yīng)激反應(yīng)的措施7周神經(jīng)分布重要的是要認(rèn)識到在皮膚、肌肉和骨骼的神經(jīng)分布之間存在差別周神經(jīng)分布8連續(xù)外周神經(jīng)阻滯(CPNB)通過在周圍神經(jīng)周圍留置導(dǎo)管并輸注局麻藥達(dá)到長時(shí)間神經(jīng)阻滯的目的連續(xù)外周神經(jīng)阻滯(CPNB)9CPNB的指征術(shù)后急性疼痛治療長時(shí)間的臨床麻醉治療打嗝外周血管擴(kuò)張的需要:斷肢再植后輔助治療雷諾病■外周血管栓塞慢性疼痛治療CPNB的指征10連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件11連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件12連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件13連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件14連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件15連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件16連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件17連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件18連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件19連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件20連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件21連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件22連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件23連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件24連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件25連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件26連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件27連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件28連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件29連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件30連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件31連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件32連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件33連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件34連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件35連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件36連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件37連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件38連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件39連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件40連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件41連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件42連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件43連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件44連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件45連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件46連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件47連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件48連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件49連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件50連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件51連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件52連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件53連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件54連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件55連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件56連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件57連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件58連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件59連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件60連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件61連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件62連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件63連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件64連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件65連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件66連續(xù)外周神經(jīng)阻滯在術(shù)后鎮(zhèn)痛中的應(yīng)用附屬第一醫(yī)院連續(xù)外周神經(jīng)阻滯在術(shù)后67神經(jīng)阻滯的概直接在末梢的神經(jīng)干、叢,腦脊神經(jīng)根、交感神經(jīng)節(jié)等神經(jīng)組織內(nèi)或附近注射藥物或給予物理刺激而阻斷神經(jīng)功能傳導(dǎo)稱為神經(jīng)阻滯化學(xué)性神經(jīng)阻滯療法主要采用局部麻醉藥物阻斷神經(jīng)傳導(dǎo)功能,可用于手術(shù)中鎮(zhèn)痛,而更多的是用于疼痛治療。使用高濃度的局麻藥或神經(jīng)破壞藥物進(jìn)行神經(jīng)阻滯,可長時(shí)間甚至永久性地(不可逆性的)阻斷神經(jīng)傳導(dǎo)功能,被稱為神經(jīng)破壞性阻滯神經(jīng)阻滯的概68神經(jīng)阻滯治療疼痛的特點(diǎn)在最短的時(shí)間內(nèi)、以最快的速度將最合理的藥物、準(zhǔn)確地注射到最需要的病變部位。■鎮(zhèn)痛效果確實(shí)可靠。對疾病的診斷具有重要意義?！鲋委煼秶皶r(shí)效可選擇性強(qiáng)。副作用小■操作簡便易學(xué)神經(jīng)阻滯治療疼痛的特點(diǎn)69大腦皮中央后回痛覺傳導(dǎo)通路疼痛是機(jī)體對傷害性丘腦刺激的感覺釋義。傷害性刺激是沿著周圍神經(jīng)①、②和③分別傳導(dǎo)至中樞神經(jīng)系統(tǒng),來一級第二級和第三級神并在此產(chǎn)生反應(yīng)以保護(hù)機(jī)體免遭傷害。受大腦皮70手術(shù)疼痛及其應(yīng)激反應(yīng)的處理一焦慮下丘腦下丘腦阿片類藥饑餓熱丟失激素←合成分解激素的調(diào)控酸中毒缺氧冬痛緩解藥傳入刺激(疼痛)神經(jīng)元阻斷局部組織因子(疼痛因子調(diào)節(jié)、給予手術(shù)疼痛及其應(yīng)激反應(yīng)的處理71傳入迷走神經(jīng)未阻滯神經(jīng)阻滯←膈傳人迷走神經(jīng)未阻滯不能完全答/)+傳入交感神經(jīng)阻滯不全抑制手術(shù)|○應(yīng)激反應(yīng)傳人軀體神經(jīng)阻滯不全的原因一骨盆傳入神經(jīng)未阻滯潛在的體液釋放機(jī)制熱丟失(顫抖)神經(jīng)阻滯不能完全抑制手術(shù)應(yīng)急反應(yīng)的因素傳入迷走神經(jīng)未阻滯72抑制手術(shù)應(yīng)激反應(yīng)的措施全身阿片類藥a2激動(dòng)劑外周神經(jīng)阻滯冷卻鎮(zhèn)痛蛛網(wǎng)膜下腔阻滯硬膜外阻滯阿片類藥(硬膜外蛛網(wǎng)膜下腔)生長激素釋放抑制因子電刺激(TENS)抗組胺藥,糖皮質(zhì)激素氯胺酮環(huán)氧酶抑制劑,局麻藥P物質(zhì)拮抗劑,阿片類藥抑制手術(shù)應(yīng)激反應(yīng)的措施73周神經(jīng)分布重要的是要認(rèn)識到在皮膚、肌肉和骨骼的神經(jīng)分布之間存在差別周神經(jīng)分布74連續(xù)外周神經(jīng)阻滯(CPNB)通過在周圍神經(jīng)周圍留置導(dǎo)管并輸注局麻藥達(dá)到長時(shí)間神經(jīng)阻滯的目的連續(xù)外周神經(jīng)阻滯(CPNB)75CPNB的指征術(shù)后急性疼痛治療長時(shí)間的臨床麻醉治療打嗝外周血管擴(kuò)張的需要:斷肢再植后輔助治療雷諾病■外周血管栓塞慢性疼痛治療CPNB的指征76連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件77連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件78連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件79連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件80連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件81連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件82連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件83連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件84連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件85連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件86連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件87連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件88連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件89連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件90連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件91連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件92連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件93連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件94連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件95連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件96連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件97連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件98連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件99連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件100連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件101連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件102連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件103連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件104連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件105連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件106連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件107連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件108連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件109連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件110連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件111連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件112連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件113連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件114連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件115連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件116連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件117連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件118連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件119連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件120連續(xù)外周神經(jīng)阻滯臨床應(yīng)用課件121連續(xù)外