腰穿提高篇精选PPT.ppt

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1、关于腰穿提高篇第1页，讲稿共21张，创作于星期三腰穿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心理一定要稳定第2页，讲稿共21张，创作于星期三理想与现实是有差距的第3页，讲稿共21张，创作于星期三体位: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 th

2、e edge of the bed and the plane of the back and shoulders as perpendicular to the bed as possible.第4页，讲稿共21张，创作于星期三体位第5页，讲稿共21张，创作于星期三体位第6页，讲稿共21张，创作于星期三体位第7页，讲稿共21张，创作于星期三与床面的关系：两条垂直线，一条平行线第8页，讲稿共21张，创作于星期三间隙nDrawing an imaginary line between the two posterior iliac crests will allow identification

3、 of the L3-4 or L4-5 interspaces.第9页，讲稿共21张，创作于星期三确定中点第10页，讲稿共21张，创作于星期三进针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.第11页，讲稿共21张，创作于星期三

4、进针第12页，讲稿共21张，创作于星期三理想与现实还是有差距的第13页，讲稿共21张，创作于星期三进针层次第14页，讲稿共21张，创作于星期三矢状面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 fl

5、avum(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).第15页，讲稿共21张，创作于星期三水平面nHorizontal section of lumbar vertebra illustrating the course of the lumbar puncture needle thr

6、ough 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).第16页，讲稿共21张，创作于星期三进针第17页，讲稿共21张，创作于星期三心理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，往往会带来不顺利第18页，讲稿共21张，创作于星期三总结第19页，讲稿共21张，创作于星期三参考文献nBoon JM,Abrahams PH,Meiring JH,et al.Lumbar puncture:anatomical review of a clinical skill.Clin Anat 2004;17(7):544-53.第20页，讲稿共21张，创作于星期三感谢大家观看第21页，讲稿共21张，创作于星期三