超声在麻醉和疼痛医学中应用(final).ppt

 超声在麻醉与疼痛医学中的应用Application of ultrasound in anesthesia and pain medicine 上海交通大学附属第六人民医院麻醉科 　 W. Jiang 麻醉与超声 Anaesthesia and ultrasound 传统麻醉 → 现代麻醉 traditional anaesthesia → modern anaesthesia 药物 : 单一，不良反应多 → 选择↑，安全性↑，可控性↑ 技术 : 盲探操作 → 可视操作 理论 : 麻醉基础和临床理论日益丰富 超声技术与麻醉 ultrasound technique and anaesthesia 以其独特优点成为近年热点, 方兴未艾 喻为现代麻醉医生的“第三只眼睛” 麻醉各领域广泛应用 内 容 Contents 原理 principles of ultrasound technology 不同的人体解剖结构均有各自的反射特性 different human anatomical structures have varying reflective properties 反射（回声）能够被超声探头收集 the reflection (echo) is collected by the probe 反射的信号经放大处理后显示在数字监测仪上 the amplitude of reflected signal is displayed on a digital monitor 组织回声 different type of ultrasound “高回声”结构－“亮”图像（如：骨、腱） “hyperechoic” structures － “bright” on screen (e.g. bone, tendons) “低回声”结构－“暗”图像（如：脂肪、血管） “ hypoechoic” tissues － “dark” on screen (e.g. fat, vessels) 外周神经一般为高回声 peripheral nerves usually have a hyperechoic appearance 　 高频超声 higher-frequency ultrasound 高清晰度(分辨率), 低穿透力 higher resolution, low penetration 低频超声 lower-frequency ultrasound 低清晰度、高穿透力 lower image resolution, deeper penetration 位置较浅神经 superficial nerve 肌间沟、锁骨上、腋路臂丛: 10－13 MHz interscalene, supraclavicular, axillary brachial plexus 位置较深神经 deep nerve 锁骨下、腘、腰丛: 5－7 MHz Infraclavicular or popliteal region, lumbar plexus 超声引导局部麻醉 Ultrasound-guided regional anesthesia (UGRA) 平面内和平面外 in plane and out of plane 超声下肌间沟臂丛阻滞ultrasound guided interscalene brachial plexus block 超声下肌间沟臂丛阻滞ultrasound guided interscalene brachial plexus block 注射局麻药有利于靶神经结构显像 the targeted nerve structures often can be more easily identified following the injection of local anesthetic Ultrasound Imaging of the Thoracic Epidural Space. Regional Anesthesia and Pain Medicine,2002, 27(2): pp 200–206 Ultrasound Imaging of the Thoracic Epidural Space. Regional Anesthesia and Pain Medicine,2002, 27(2): pp 200–206 Ultrasoun