《躯干神经阻滞-文档资料.ppt》由会员分享，可在线阅读，更多相关《躯干神经阻滞-文档资料.ppt（56页珍藏版）》请在三一文库上搜索。
1、,躯干神经阻滞在胸腹手术中的应用,肖颖,胸壁手术镇痛方式的比较,Risk potential,胸壁神经支配,Intercostal nerve sensory distribution,Neural innervation of chest wall,硬膜外阻滞,胸椎旁阻滞,前锯肌平面阻滞 （肋间神经侧皮支）,肋间神经阻滞,胸骨旁肋间神经阻滞 (肋间神经前皮支),Thoracic Paravertebral Block,Thoracic Paravertebral Block,Thoracic Paravertebral Block,Thoracic wall block:PECS 1 + P
2、ECS 2 + PECS 3,Neural innervation of anterior chest wall and breast,Supraclavicular nerve C3-C4,Neural innervation of anterior chest wall and breast,Lateral pectoral nerve C5-C7,Medial pectoral nerve C8-T1,Neural innervation of anterior chest wall and breast,Long thoracic nerve C5-C7,Neural innervat
3、ion of anterior chest wall and breast,Thoracodorsal nerve C6-C8,Neural innervation of anterior chest wall and breast,Lateral intercostal cutaneoous nerve T2-T6,Anterior intercostal cutaneoous nerve T2-T6,Neural innervation of anterior chest wall and breast,Thoracic wall block:PECS 1 + PECS 2 + PECS
4、3,Indication: postoperative Analgesia PECS 1: Breast expander or subpectoral prostheses PECS 2: + PECS 1: Tumor resection, Mastectomy + axillary lymph node clearance PECS 3 + PECS1: Mastectomy + axillary lymph node clearance +reconstruction,Blanco R, Anaesthesia. 2011 Sep;66(9):847-8 Blanco R et al,
5、 Rev Esp Anestesiol Reanim. 2012 Nov;59(9):470-5 Blanco R et al, Anaesthesia 2013, 68, 11071113,Thoracic wall block:PECS 1 + PECS 2 + PECS 3,PECS 1 : interfascial plane between pectoralis major and minor N. pectorales medialis + lateralis (M. pectoralis major),Blanco R, Anaesthesia. 2011 Sep;66(9):8
6、47-8 Blanco R et al, Rev Esp Anestesiol Reanim. 2012 Nov;59(9):470-5 Blanco R et al, Anaesthesia 2013, 68, 11071113,2021/4/6,19,Georg Thieme Verlag,PECS 1,2021/4/6,20,PECS 1,2021/4/6,21,PECS 1: Injection,2021/4/6,22,Ast der A. thoracoacromialis,Thorax wall block:PECS 1 + PECS 2 + PECS 3,PECS 1 N. pe
7、ctorales medialis + lateralis (M. pectoralis major) PECS 2 Lateral cutaneous branch of thoracic intercostal neerve nerve T2-T6 + N. thoracicus longus (M. serratus anterior),Blanco R, Anaesthesia. 2011 Sep;66(9):847-8 Blanco R et al, Rev Esp Anestesiol Reanim. 2012 Nov;59(9):470-5 Blanco R et al, Ana
8、esthesia 2013, 68, 11071113,2021/4/6,24,Georg Thieme Verlag,M. serratus anterior,2021/4/6,25,N. spinalis,Putz/Pabst: Sobotta. Atlas der Anatomie des Menschen, 21. Aufl. Urban 66(9):847-8 Blanco R et al, Rev Esp Anestesiol Reanim. 2012 Nov;59(9):470-5 Blanco R et al, Anaesthesia 2013, 68, 11071113,Ge
9、org Thieme Verlag,2021/4/6,33,Georg Thieme Verlag,2021/4/6,34,PECS 3,2021/4/6,35,2021/4/6,36,PECS 3: sensory Blockade,Blanco R et al, Anaesthesia 2013, 68, 11071113,2021/4/6,38,腹壁手术术后镇痛方式的比较,Risk potential,2021/4/6,40,Qudratus Lumborum Block,N. spinalis,Putz/Pabst: Sobotta. Atlas der Anatomie des Me
10、nschen, 21. Aufl. Urban 32(Suppl 1):130,2021/4/6,46,Hebbard PD, J Can Anesth (2009) 56:618620,M. erector spinae,M. psoas,M. Quadratus lumborum,Rectus sheath B.,TAP B.,Quadratus lumborum B.,2021/4/6,47,Ultrasound-Guided Transmuscular Quadratus Lumborum Blockade,2021/4/6,48,Quadratus lumborum Blockade
11、,Transmuscular Quadratus lumborum Blockade,M. psoas,M. Quadratus lumborum,Transversus Abdominis plane blockade,2021/4/6,49,2021/4/6,50,ventral,posterior,anterior,dorsal,Wirbelkrper,M. psoas,Process transversus,M. erector spine,M. Quadratus lumborum,2021/4/6,51,Tansversus Abdomins Plane Blockade,2021/4/6,52,Ultrasound-Guided Transversus Abdomins Plane Block,2021/4/6,53,Ultrasound-Guided Transversus Abdomins Plane Block,2021/4/6,54,Ultrasound-Guided Transversus Abdomins Plane Blockade,2021/4/6,55,Oh, there is a block, we can do that!,专业文档最好找专业人士起草或审核后使用，感谢您的下载！,