椎管內(nèi)麻醉-intrathecal-anesthesia-全文預(yù)覽
【正文】 網(wǎng) 膜 下 腔 阻 滯（脊麻 ) Section one Subarachnoid block (spinal anesthesia) ? 定義 （ definition） The agent is injected into the CSF(cerebrospinal fluid) in the subarachnoid space of the meninges (the threelayered covering of the spinal cord) using a lumbar interspace in the vertebral column. 局麻藥 腦脊液 脊神經(jīng)、背根神經(jīng)節(jié)及脊髓表面 一、概述 (outline) 第一節(jié) 蛛 網(wǎng) 膜 下 腔 阻 滯 Section one Subarachnoid block (spinal anesthesia) ?比重： According to the differences of gravity between the local anesthetic and CSF Hyperbaric solution: It is heavier than CSF,and it can be made (重比重 ) by the addition of glucose. Hypobaric solution: It is lighter than CSF,and it can be made (輕比重 ) by the addition of sterile water. Isobaric solution: It is nearly equal to gravity of CSF, and it is (等比重 ) mixed with CSF(at least 1:1). (The gravity of CSF is ～ ) 概述 (outline) 平面： According to the level of neural blockade Spinal anesthesia high position: The sensory blockade ＞ T4 mid position: The sensory blockade≤T5—9 low position: The sensory blockade＜ T10. ―saddle block‖ (鞍麻） means that the level of neural blockade is limited to perineum(會(huì)陰 ) or hip (臀部 ). “Unilateral block‖ means that the level of neural blockade is limited to unilateral lower extremity (單側(cè)阻滯 ) 一、概述 (outline) 二、蛛網(wǎng)膜下隙阻滯的機(jī)制及其對(duì)生理的影響 (The mechanism of action and physiologic responses) 1. 直接作用 (Direct actions) : ▲ The site of action: The principal site of action is the nerve root. ▲ The sequence of block: Autonomic Nf* sensory Nf motor Nf myelinated Ar Nf * (有髓鞘的本體感覺纖維 ) ▲ The differential level of block: Sympathetic block may be 24 segments higher than sensory block, which in turn is 14 segments higher than motor block. Nf: nerve fiber 2. 間接作用 (全身影響 ): Indirect actions(systemic effects) ★ Cardiovascular manifestations——心血管系統(tǒng)影響 Sympathetic Nf block vasodilation of venous capacitance vessels capacity of venous return to heart arterial vasodilation systemic vascular resistance sympathetic cardiac accelarator fibers block HR BP Indirect actions(systemic effects) ★ Pulmonary manifestations（ 呼吸系統(tǒng)影響） ? Tidal volume remains unchanged during high spinal anesthesia, and vital capacity decreases a small amount from to L 潮氣量改變不明顯 ,肺活量少量下降 ? The rare respiratory arrest associated with spinal anesthesia is also unrelated to phrenic or inspiratory dysfunction but rather to hypoperfusion of the respiratory centers in the brainstem 呼吸暫停與腦干呼吸中樞血流灌注不足有關(guān)，與呼吸肌功能無關(guān) ★ Gastrointestinal manifestations(胃腸道影響） Spinal block sympathetic block vagal tone a contracted gut with active peristasis （內(nèi)臟收縮，蠕動(dòng) ） ★ Urinary tract manifestations（泌尿系統(tǒng)影響） Renal blood flow is maintained through autoregulation, and there is little clinical effect on renal function from spinal block. 腎功能影響小 三、蛛網(wǎng)膜下腔阻滯的臨床應(yīng)用 (The clinical applications of subarachnoid block) (一 )適應(yīng)證 (indications)： ?下腹部手術(shù)，如：闌尾切除術(shù)、疝修補(bǔ)術(shù) ?肛門及會(huì)陰部手術(shù)，如：痔切除術(shù) ?盆腔手術(shù)，如：子宮切除、膀胱手術(shù) ?下肢手術(shù)，如：截肢手術(shù) ( 二 ) 禁忌證 (contraindications) ?Absolute contraindications ? Infection at the site of injection ? Patient refusal ? Coagulopathy or other bleeding diathesis ? Severe hypovolemia ? Incr
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