腰穿提高篇课件.ppt
关于腰穿提高篇现在学习的是第1页，共21页腰穿n解剖一定要弄清n体位一定要摆好n间隙一定要摸准n进针一定要垂直n心理一定要稳定现在学习的是第2页，共21页理想与现实是有差距的现在学习的是第3页，共21页体位:lateral decubitus positionnThe patient is placed curled on his side,on a firm surface,with his knees flexed up to the chest and neck flexed forward.The lumbar region should be close to the edge of the bed and the plane of the back and shoulders as perpendicular to the bed as possible.现在学习的是第4页，共21页体位现在学习的是第5页，共21页体位现在学习的是第6页，共21页体位现在学习的是第7页，共21页与床面的关系：两条垂直线，一条平行线现在学习的是第8页，共21页间隙nDrawing an imaginary line between the two posterior iliac crests will allow identification of the L3-4 or L4-5 interspaces.现在学习的是第9页，共21页确定中点现在学习的是第10页，共21页进针nInsert spinal needle,with stylet in place,along the midline with bevel facing upwards(assumes lateral decubitus positioning).Direct the needle slightly cephalad along an imaginary line towards the umbilicus.现在学习的是第11页，共21页进针现在学习的是第12页，共21页理想与现实还是有差距的现在学习的是第13页，共21页进针层次现在学习的是第14页，共21页矢状面nSagittal section of lumbar vertebrae illustrating the course of the lumbar puncture needle through skin(1),subcutaneous tissue(2),supraspinous ligament(3),interspinous ligament(5)between the spinous processes(4),ligamentum flavum(6),dura mater(8),into the subarachnoid space and between the nerve roots of the cauda equina(7).Lumbar vertebral bodies(9),intervertebral disc(10),and lumbar puncture needle(11).现在学习的是第15页，共21页水平面nHorizontal section of lumbar vertebra illustrating the course of the lumbar puncture needle through skin(1),subcutaneous tissue(2),between the spinous processes(3)and laminae(4),ligamentum flavum(5),epidural space(6),dura mater(7),into the subarachnoid space and between the nerve roots of the cauda equina(8).Lumbar vertebral body(9)and lumbar puncture needle(10).现在学习的是第16页，共21页进针现在学习的是第17页，共21页心理n家属回避n不要分心：不要象有些人风一样飘来飘去，一会接电话，一会和别人开玩笑n切忌大意：有时候在给自己已经穿过的患者再次腰穿时，由于思想上放松警惕，往往会带来不顺利现在学习的是第18页，共21页总结现在学习的是第19页，共21页参考文献nBoon JM,Abrahams PH,Meiring JH,et al.Lumbar puncture:anatomical review of a clinical skill.Clin Anat 2004;17(7):544-53.现在学习的是第20页，共21页感感谢谢大大家家观观看看现在学习的是第21页，共21页
