超聲引導(dǎo)下豎脊肌阻滯在臨床應(yīng)用-PPT課件

1、超超聲引導(dǎo)下豎脊肌平面阻滯聲引導(dǎo)下豎脊肌平面阻滯的臨床應(yīng)用的臨床應(yīng)用內(nèi)容一、筋膜和筋膜平面阻滯概況一、筋膜和筋膜平面阻滯概況二、豎脊肌平面阻滯在胸科二、豎脊肌平面阻滯在胸科手手術(shù)的術(shù)的應(yīng)應(yīng)用用 三、豎脊肌平面阻滯在腹部三、豎脊肌平面阻滯在腹部手手術(shù)的術(shù)的應(yīng)應(yīng)用用 四、豎脊肌四、豎脊肌平平面阻滯在脊柱面阻滯在脊柱手手術(shù)的術(shù)的應(yīng)用應(yīng)用筋膜平面阻筋膜平面阻滯滯 Fascial plane blocksPECS blockQuadratus lumborum blockSerratus plane blockTransversus abdominis plane blockThe erector sp

2、inae plane block: plane and simple. El-Boghdadly K, Pawa A. Anaesthesia. 2017 Apr;72(4):434-438.“詭異的筋膜”麻醉麻醉為筋膜平面阻滯提供空間疼痛疼痛人體生物力學(xué)調(diào)控胸腰筋膜麻醉麻醉 腰方肌阻滯 豎脊肌平面阻豎脊肌平面阻滯滯胸腰筋膜平面阻滯胸腰筋膜平面阻滯疼痛疼痛 調(diào)節(jié)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)下豎脊肌平面阻滯超聲引導(dǎo)下豎脊肌平面阻滯在胸科在胸科手手術(shù)術(shù)的的臨床應(yīng)用臨床應(yīng)用超聲引導(dǎo)下豎脊肌平面阻滯Forero M, Adhikary SD, Lopez

3、 H, et al. The Erector Spinae Plane Block: A Novel Analgesic Technique in Thoracic Neuropathic Pain. Reg Anesth Pain Med. 2016,41(5):621-627.T5橫突豎脊肌平面阻滯范圍T5橫突豎脊肌平面 阻滯范圍驗證豎脊肌平面阻滯的有效性和安全性驗證豎脊肌平面阻滯的有效性和安全性隨機對照研究隨機對照研究持續(xù)豎脊肌平面阻滯首次劑首次劑量量 25ml 0.5%羅哌卡因；鎮(zhèn)痛羅哌卡因；鎮(zhèn)痛泵泵 8ml/h 0.2%羅哌卡因，羅哌卡因，bolus 5ml ，鎖定，鎖定60min超

4、聲引導(dǎo)下豎脊肌平面阻滯超聲引導(dǎo)下豎脊肌平面阻滯在腹部在腹部手手術(shù)術(shù)的的臨床應(yīng)用臨床應(yīng)用雙雙側(cè)側(cè)T7豎脊肌平面豎脊肌平面 阻滯用于腹壁疝手阻滯用于腹壁疝手 術(shù)鎮(zhèn)痛術(shù)鎮(zhèn)痛雙雙側(cè)側(cè)T7豎脊肌平面豎脊肌平面 阻滯用于減肥手術(shù)阻滯用于減肥手術(shù) 鎮(zhèn)痛鎮(zhèn)痛雙側(cè)雙側(cè)T8持續(xù)豎脊肌持續(xù)豎脊肌 平面阻滯用于膀胱平面阻滯用于膀胱 前列腺切除術(shù)前列腺切除術(shù)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：3ml 2%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%布比卡因豎脊肌平面阻滯原理Boezaart, A.P. Atlas of Peripheral

5、Nerve blocks and Anatomy for Orthopaedic Anesthesia. 2008Forero M, Adhikary SD, Lopez H, et al. The Erector Spinae Plane Block: A Novel Analgesic Technique in Thoracic Neuropathic Pain. Reg Anesth Pain Med. 2016,41(5):621- 627.豎脊肌平面阻滯解剖示意圖Chin KJ, Malhas L, Perlas A. The Erector Spinae Plane Block P

6、rovides Visceral Abdominal Analgesia in Bariatric Surgery: A Report of 3 Cases. Reg Anesth Pain Med. 2017豎脊肌平面阻滯與后椎板阻滯1. Pfeiffer G1, Oppitz N, Schne S, et al.Analgesia of the axilla using a paravertebral catheter in the lamina technique. Anaesthesist. 2006 Apr;55(4):423-7.2. Jttner T1, Werdehausen

7、R, Hermanns H, et al. The paravertebral lamina technique: a new regional anesthesia approach for breast surgery. J Clin Anesth. 2011 Sep;23(6):443-50.超聲引導(dǎo)下豎脊肌平面阻滯超聲引導(dǎo)下豎脊肌平面阻滯在在脊柱脊柱手手術(shù)術(shù)的的臨床應(yīng)用臨床應(yīng)用CorrespondenceClinical experiences of ultrasound- guided erector spinae plane block for thoracic vertebra surgeryContents lists available at ScienceDirect)ournal of Clinical AnesthesiabanzhtntrnaRhomBoid UI |QF FfHJSEl9總結(jié) 胸腰筋膜在麻醉/疼痛領(lǐng)域有