超声技术在麻醉科PPT课件
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15
超声引导下区分动静脉
16
超声引导下区分动静脉
9
传统颈内静脉置管：
胸锁乳突肌三角定位
10
穿刺困难的患者
颈部畸形 颈部僵硬 插管部位有外科手术史 无法平卧
11
超声引导深静脉置管适应症
可以是任何病人!
操作困难病人
解剖变异 血栓
肥胖
12
12
颈内静脉的位置变异相当常见
Variable location of Internal Jugular Vein
Anesth Analg. 2011 Jul;113(1):1343 -7
什么是超声波
人能听到的声音范围是20赫兹-20000赫兹 超声波是声源振动的频率大于20000赫兹 的机械波 超声探头就是把电能转化为超声机械能的装置
4
血管穿刺
超
声
应
神经阻滞
用
临床监护＆指导治疗
5
Anatomy of the ultrasound beam超声束的解读
examination showed adequate mouth opening with
normal dentition, Mallampati grade IV, and restricted
neck mobility.
Anesth Analg. 2011 Jul;113(1):134-72
Bilateral ultrasound-guided transversus abdomini plane blockcombined with ilioinguinal-iliohypogastric nerve block for cesarean delivery anesthesia
左侧颈内静脉
右侧颈内静脉
左侧
14%
70%
1%
14%
0%
18%
1%
66%
14% 1%
Fra Baidu bibliotek
右侧
➢ 如颈内静脉不在颈总动脉外侧, 那以动脉为标志的穿刺法难于确定穿刺
方向, 成功率将难以保证。
➢ 颈内静脉随着颈部旋转而移动。
13
右颈内静脉的解剖变异
动脉外上方
动脉正上方
14
超声引导技术的优点
确定目标血管 确定尺寸, 位置 明确异常的解剖结构 减少病人的痛苦和焦虑 减少穿刺失败率和相关的并发症
超声技术在临床麻醉中的应用
郑州大学第一附属医院麻醉科 彭周全
1
病例1
➢ Case1 A 28-year-old woman with a history of ankylosing
spondylitis was admitted to our hospital at 39 weeks'
gestation. She was 159 cm tall and weighed 74 kg (BMI:
不同组织的成像特点
动脉 无回声，有搏动 静脉 无回声，可压缩
肌肉 筋膜高回声，肌肉低回声
肌腱 神经
骨骼
管状高回声线条（纤维状） 横向-高回声晕包绕的圆或椭圆低回声区 纵向-管状非连续低回声线条，高回声线条分隔 明亮高回声骨膜，后方有黑色阴影
7
超声引导下血管穿刺
8
深静脉置管
深静脉置管可用于血液动力学 监测、给予血管活性药物、静脉取 样、补液以及胃肠外营养。因此深 静脉穿刺技术对于麻醉医生是必需 的一项技能。
29.3 kg/m2). A past radiograph showed fusion of the
spine from the cervical to the lumbar regions, and an
ossified ligamentum lavumf. Preoperative airway
Abstract The ultrasound-guided transversus abdominis plane block and ilioinguinal-iliohypogastric nerve block have been shown to provide pain relief after abdominal surgery. A combination of the 2 blocks may provide acceptable surgical anesthesia for cesarean delivery. We describe 4 women who had contraindications to neuraxial anesthesia, who underwent cesarean delivery with ultrasound-guided bilateral transversus abdominis plane block combined with ilioinguinal-iliohypogastric nerve block using 40 mL 0.5% ropivacaine. Breakthrough pain during the delivery of the fetus was treated with small doses of IV ketamine and propofol. We suggest that this technique may be an alternative to local anesthesia for cesarean delivery in clinical practice.
Mei W, Jin C, Feng L, Zhang Y, Luo A, Zhang C, Tian Y.
Department of AnesthesiologyH, Tongji oital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Ave. 1095#, 430030 Wuhan, China.
Sound wave is focused into a thin “slice”声波集中到一个薄片上 Approximate thickness of a credit card近似一张信用卡的厚度 (超声波切面的宽度一般在0.3mm) 因此穿刺针越细，越不易在超声图像中显示
6
超声图像识别和获取
超声引导下区分动静脉
16
超声引导下区分动静脉
9
传统颈内静脉置管：
胸锁乳突肌三角定位
10
穿刺困难的患者
颈部畸形 颈部僵硬 插管部位有外科手术史 无法平卧
11
超声引导深静脉置管适应症
可以是任何病人!
操作困难病人
解剖变异 血栓
肥胖
12
12
颈内静脉的位置变异相当常见
Variable location of Internal Jugular Vein
Anesth Analg. 2011 Jul;113(1):1343 -7
什么是超声波
人能听到的声音范围是20赫兹-20000赫兹 超声波是声源振动的频率大于20000赫兹 的机械波 超声探头就是把电能转化为超声机械能的装置
4
血管穿刺
超
声
应
神经阻滞
用
临床监护＆指导治疗
5
Anatomy of the ultrasound beam超声束的解读
examination showed adequate mouth opening with
normal dentition, Mallampati grade IV, and restricted
neck mobility.
Anesth Analg. 2011 Jul;113(1):134-72
Bilateral ultrasound-guided transversus abdomini plane blockcombined with ilioinguinal-iliohypogastric nerve block for cesarean delivery anesthesia
左侧颈内静脉
右侧颈内静脉
左侧
14%
70%
1%
14%
0%
18%
1%
66%
14% 1%
Fra Baidu bibliotek
右侧
➢ 如颈内静脉不在颈总动脉外侧, 那以动脉为标志的穿刺法难于确定穿刺
方向, 成功率将难以保证。
➢ 颈内静脉随着颈部旋转而移动。
13
右颈内静脉的解剖变异
动脉外上方
动脉正上方
14
超声引导技术的优点
确定目标血管 确定尺寸, 位置 明确异常的解剖结构 减少病人的痛苦和焦虑 减少穿刺失败率和相关的并发症
超声技术在临床麻醉中的应用
郑州大学第一附属医院麻醉科 彭周全
1
病例1
➢ Case1 A 28-year-old woman with a history of ankylosing
spondylitis was admitted to our hospital at 39 weeks'
gestation. She was 159 cm tall and weighed 74 kg (BMI:
不同组织的成像特点
动脉 无回声，有搏动 静脉 无回声，可压缩
肌肉 筋膜高回声，肌肉低回声
肌腱 神经
骨骼
管状高回声线条（纤维状） 横向-高回声晕包绕的圆或椭圆低回声区 纵向-管状非连续低回声线条，高回声线条分隔 明亮高回声骨膜，后方有黑色阴影
7
超声引导下血管穿刺
8
深静脉置管
深静脉置管可用于血液动力学 监测、给予血管活性药物、静脉取 样、补液以及胃肠外营养。因此深 静脉穿刺技术对于麻醉医生是必需 的一项技能。
29.3 kg/m2). A past radiograph showed fusion of the
spine from the cervical to the lumbar regions, and an
ossified ligamentum lavumf. Preoperative airway
Abstract The ultrasound-guided transversus abdominis plane block and ilioinguinal-iliohypogastric nerve block have been shown to provide pain relief after abdominal surgery. A combination of the 2 blocks may provide acceptable surgical anesthesia for cesarean delivery. We describe 4 women who had contraindications to neuraxial anesthesia, who underwent cesarean delivery with ultrasound-guided bilateral transversus abdominis plane block combined with ilioinguinal-iliohypogastric nerve block using 40 mL 0.5% ropivacaine. Breakthrough pain during the delivery of the fetus was treated with small doses of IV ketamine and propofol. We suggest that this technique may be an alternative to local anesthesia for cesarean delivery in clinical practice.
Mei W, Jin C, Feng L, Zhang Y, Luo A, Zhang C, Tian Y.
Department of AnesthesiologyH, Tongji oital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Ave. 1095#, 430030 Wuhan, China.
Sound wave is focused into a thin “slice”声波集中到一个薄片上 Approximate thickness of a credit card近似一张信用卡的厚度 (超声波切面的宽度一般在0.3mm) 因此穿刺针越细，越不易在超声图像中显示
6
超声图像识别和获取