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神經(jīng)刺激器引導(dǎo)腰叢和坐骨神經(jīng)阻滯神經(jīng)刺激器引導(dǎo)1為什么需要腰叢+坐骨神經(jīng)阻滯■與腰麻和硬膜外麻醉相比→時(shí)間更長(zhǎng)止血帶反應(yīng)輕微或缺如→無(wú)尿潴留實(shí)施抗凝治療的病人相對(duì)安全為什么需要腰叢+坐骨神經(jīng)阻滯2下肢的神經(jīng)解剖腰叢:T12(50%),L14■坐骨神經(jīng)L4~S3→6個(gè)終末支÷臀神經(jīng)L4~S2→3個(gè)支配下肢股神經(jīng)L24脛神經(jīng)L4~S3股外側(cè)皮神經(jīng)L23腓神經(jīng)L4~S閉孔神經(jīng)L■深支和淺支→另外3個(gè)終末支→腓腸成分■髂腹下神經(jīng)T12,L1髂腹股溝神經(jīng)L1→股后側(cè)成分■生殖股神經(jīng)L1股后皮神經(jīng)下肢的神經(jīng)解剖3下肢的神經(jīng)解剖(前面和側(cè)面觀)L1-L5=Lumbarplexuss1·S4=SacralplexusiliacusinquangearedObturatorn下肢的神經(jīng)解剖(前面和側(cè)面觀)4下肢淺表神經(jīng)支配PosteriorsaphenousnSuralnTibaln下肢淺表神經(jīng)支配5腰叢與坐骨神經(jīng)阻滯課件6腰叢與坐骨神經(jīng)阻滯課件7腰叢與坐骨神經(jīng)阻滯課件8腰叢與坐骨神經(jīng)阻滯課件9腰叢與坐骨神經(jīng)阻滯課件10腰叢與坐骨神經(jīng)阻滯課件11腰叢與坐骨神經(jīng)阻滯課件12腰叢與坐骨神經(jīng)阻滯課件13腰叢與坐骨神經(jīng)阻滯課件14腰叢與坐骨神經(jīng)阻滯課件15腰叢與坐骨神經(jīng)阻滯課件16腰叢與坐骨神經(jīng)阻滯課件17腰叢與坐骨神經(jīng)阻滯課件18腰叢與坐骨神經(jīng)阻滯課件19腰叢與坐骨神經(jīng)阻滯課件20腰叢與坐骨神經(jīng)阻滯課件21腰叢與坐骨神經(jīng)阻滯課件22腰叢與坐骨神經(jīng)阻滯課件23腰叢與坐骨神經(jīng)阻滯課件24腰叢與坐骨神經(jīng)阻滯課件25腰叢與坐骨神經(jīng)阻滯課件26腰叢與坐骨神經(jīng)阻滯課件27腰叢與坐骨神經(jīng)阻滯課件28腰叢與坐骨神經(jīng)阻滯課件29腰叢與坐骨神經(jīng)阻滯課件30腰叢與坐骨神經(jīng)阻滯課件31腰叢與坐骨神經(jīng)阻滯課件32腰叢與坐骨神經(jīng)阻滯課件33腰叢與坐骨神經(jīng)阻滯課件34腰叢與坐骨神經(jīng)阻滯課件35腰叢與坐骨神經(jīng)阻滯課件36腰叢與坐骨神經(jīng)阻滯課件37腰叢與坐骨神經(jīng)阻滯課件38腰叢與坐骨神經(jīng)阻滯課件39腰叢與坐骨神經(jīng)阻滯課件40腰叢與坐骨神經(jīng)阻滯課件41腰叢與坐骨神經(jīng)阻滯課件42腰叢與坐骨神經(jīng)阻滯課件43腰叢與坐骨神經(jīng)阻滯課件44腰叢與坐骨神經(jīng)阻滯課件45腰叢與坐骨神經(jīng)阻滯課件46腰叢與坐骨神經(jīng)阻滯課件47腰叢與坐骨神經(jīng)阻滯課件48腰叢與坐骨神經(jīng)阻滯課件49腰叢與坐骨神經(jīng)阻滯課件50腰叢與坐骨神經(jīng)阻滯課件51腰叢與坐骨神經(jīng)阻滯課件52腰叢與坐骨神經(jīng)阻滯課件53腰叢與坐骨神經(jīng)阻滯課件54腰叢與坐骨神經(jīng)阻滯課件55神經(jīng)刺激器引導(dǎo)腰叢和坐骨神經(jīng)阻滯神經(jīng)刺激器引導(dǎo)56為什么需要腰叢+坐骨神經(jīng)阻滯■與腰麻和硬膜外麻醉相比→時(shí)間更長(zhǎng)止血帶反應(yīng)輕微或缺如→無(wú)尿潴留實(shí)施抗凝治療的病人相對(duì)安全為什么需要腰叢+坐骨神經(jīng)阻滯57下肢的神經(jīng)解剖腰叢:T12(50%),L14■坐骨神經(jīng)L4~S3→6個(gè)終末支÷臀神經(jīng)L4~S2→3個(gè)支配下肢股神經(jīng)L24脛神經(jīng)L4~S3股外側(cè)皮神經(jīng)L23腓神經(jīng)L4~S閉孔神經(jīng)L■深支和淺支→另外3個(gè)終末支→腓腸成分■髂腹下神經(jīng)T12,L1髂腹股溝神經(jīng)L1→股后側(cè)成分■生殖股神經(jīng)L1股后皮神經(jīng)下肢的神經(jīng)解剖58下肢的神經(jīng)解剖(前面和側(cè)面觀)L1-L5=Lumbarplexuss1·S4=SacralplexusiliacusinquangearedObturatorn下肢的神經(jīng)解剖(前面和側(cè)面觀)59下肢淺表神經(jīng)支配PosteriorsaphenousnSuralnTibaln下肢淺表神經(jīng)支配60腰叢與坐骨神經(jīng)阻滯課件61腰叢與坐骨神經(jīng)阻滯課件62腰叢與坐骨神經(jīng)阻滯課件63腰叢與坐骨神經(jīng)阻滯課件64腰叢與坐骨神經(jīng)阻滯課件65腰叢與坐骨神經(jīng)阻滯課件66腰叢與坐骨神經(jīng)阻滯課件67腰叢與坐骨神經(jīng)阻滯課件68腰叢與坐骨神經(jīng)阻滯課件69腰叢與坐骨神經(jīng)阻滯課件70腰叢與坐骨神經(jīng)阻滯課件71腰叢與坐骨神經(jīng)阻滯課件72腰叢與坐骨神經(jīng)阻滯課件73腰叢與坐骨神經(jīng)阻滯課件74腰叢與坐骨神經(jīng)阻滯課件75腰叢與坐骨神經(jīng)阻滯課件76腰叢與坐骨神經(jīng)阻滯課件77腰叢與坐骨神經(jīng)阻滯課件78腰叢與坐骨神經(jīng)阻滯課件79腰叢與坐骨神經(jīng)阻滯課件80腰叢與坐骨神經(jīng)阻滯課件81腰叢與坐骨神經(jīng)阻滯課件82腰叢與坐骨神經(jīng)阻滯課件83腰叢與坐骨神經(jīng)阻滯課件84腰叢與坐骨神經(jīng)阻滯課件85腰叢與坐骨神經(jīng)阻滯課件86腰叢與坐骨神經(jīng)阻滯課件87腰叢與坐骨神經(jīng)阻滯課件88腰叢與坐骨神經(jīng)阻滯課件89腰叢與坐骨神經(jīng)阻滯課件90腰叢與坐骨神經(jīng)阻滯課件91腰叢與坐骨神經(jīng)阻滯課件92腰叢與坐骨神經(jīng)阻滯課件93腰叢與坐骨神經(jīng)阻滯課件94腰叢與坐骨神經(jīng)阻滯課件95腰叢與坐骨神經(jīng)阻滯課件96腰叢與坐骨神經(jīng)阻滯課件97腰叢與坐骨神經(jīng)阻滯課件98腰叢與坐骨神經(jīng)阻滯課件99腰叢與坐骨神經(jīng)阻滯課件100腰叢與坐骨神經(jīng)阻滯課件101腰叢與坐骨神經(jīng)阻滯課件102腰叢與坐骨神經(jīng)

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