頭面部的神經(jīng)阻滯服從真理，就能征服一切事物頭面部的神經(jīng)阻滯服從真理，就能征服一切事物1頭面部疼痛的神經(jīng)阻滯中日友好醫(yī)院疼痛科水源頭面部疼痛的神經(jīng)阻滯2神經(jīng)阻滯:在木梢的腦育疃神經(jīng)節(jié)腦脊髖神物或以物予刺激,阻斷神局麻麻醉藥掌月厚→可逆的高濃度化學(xué)性神經(jīng)阻滯神經(jīng)破壞藥等似·非可逆的電物理性如壓穿剌壓法冷卻。冷凍阻滯圖3-1廣義上的神還阻滯神經(jīng)阻滯:在木梢的腦育疃神經(jīng)節(jié)腦脊髖神3作用機(jī)制減少神經(jīng)細(xì)胞膜的鈉離子內(nèi)流降低動(dòng)作電位幅度抑制動(dòng)作電位抑制神經(jīng)沖動(dòng)的產(chǎn)生作用機(jī)制4DurationofactionDependantuponproteinbindingandbloodsupplyOnsetofActionDurationofMaximumActionforAllowableAgent.:.ConcentrationInfiltrationBlockLidocaine1%,2%Immediate4-10Min30-120Min4.5mg/kgof1%(Xylocaine)LidocaineImmediate4-10Min60-240Min.7mg/kgoif-ageadult650mlperaverageadult)Imediate6-10Min90-180Min5mg/kgof1%(Carbocaine(40mlperaverageadult)05Slower8-12Min240-480Min3mg/kgof.25%(70mlperaverageadultSensorcaineSeetext5-15Min20-30Min2-5mlofmixtureDurationofaction5物理性神經(jīng)阻滯:加熱到80℃進(jìn)行神經(jīng)阻滯的電卻到80℃的冷凍傷方法進(jìn)行的神經(jīng)阻滯,它是對(duì)面肌痙攣用面神刺壓迫來(lái)進(jìn)行治療的方法“封閉”與“神經(jīng)阻滯”。兩個(gè)不同的方法和概封閉濃度局麻藥在臟器周止強(qiáng)烈的刺激向中樞傳導(dǎo),促進(jìn)中樞神經(jīng)的負(fù)誘導(dǎo)和保護(hù)性抑制,例如,腎囊封是用闌尾切除術(shù)、腹股溝疝術(shù)時(shí)強(qiáng)烈的反射向中樞傳導(dǎo)。物理性神經(jīng)阻滯:加熱到80℃進(jìn)行神經(jīng)阻滯的電6神經(jīng)阻滯的分類(lèi)從疼痛診療的角度,根據(jù)神經(jīng)阻滯的目的:①為手術(shù)、檢査的目的進(jìn)行神經(jīng)阻滯,此時(shí)可稱(chēng)為麻醉②為治療疼痛病癥而進(jìn)行神經(jīng)阻滯時(shí),稱(chēng)為治療性神經(jīng)阻滯③為診斷或鑒別診斷的目的而進(jìn)行神經(jīng)阻滯時(shí),稱(chēng)為診斷性神經(jīng)阻滯④為判定疼痛病癥的預(yù)后的目的而進(jìn)行神經(jīng)阻滯時(shí),稱(chēng)為預(yù)后判定性神經(jīng)阻滯神經(jīng)阻滯的分類(lèi)7神經(jīng)阻滯(解剖部位)分類(lèi)①脊神經(jīng)阻滯:肋間神經(jīng)阻滯、胸及腰部椎旁神經(jīng)阻滯、臂叢阻滯、枕神經(jīng)阻滯、頸叢阻滯、其他末梢神經(jīng)阻滯②交感神經(jīng)阻滯:腹腔神經(jīng)叢阻滯、胸及腰部交感經(jīng)節(jié)阻滯、星狀神經(jīng)節(jié)阻滯。③脊神經(jīng)和交感神經(jīng)同時(shí)阻滯:骶管阻滯、蛛網(wǎng)膜下腔阻滯、硬膜外阻滯(頸部、胸部、腰部)。④腦神經(jīng)阻滯:舌咽神經(jīng)阻滯、面神經(jīng)阻滯、三叉神經(jīng)阻滯(解剖部位)分類(lèi)8砷經(jīng)阻滯療法的機(jī)制阻斷疼痛的傳導(dǎo)通道°阻斷疼痛的惡性循環(huán)改善血流狀態(tài)抗炎癥作用砷經(jīng)阻滯療法的機(jī)制9砷經(jīng)阻滯療法的特點(diǎn)神經(jīng)阻滯療法的治痛效果明顯可靠對(duì)診斷疾病非常有用°局麻藥和神經(jīng)破壞藥均可應(yīng)用除特殊操作外不需特殊儀器設(shè)備操作技巧和療效密切相關(guān)砷經(jīng)阻滯療法的特點(diǎn)10頭面部神經(jīng)阻滯的分類(lèi)三叉神經(jīng)及其分支阻滯蝶鄂神經(jīng)節(jié)阻滯面神經(jīng)阻滯舌咽神經(jīng)阻滯枕神經(jīng)阻滯星狀神經(jīng)節(jié)阻滯頭面部神經(jīng)阻滯的分類(lèi)11頭面部的神經(jīng)阻滯課件12頭面部的神經(jīng)阻滯課件13頭面部的神經(jīng)阻滯課件14頭面部的神經(jīng)阻滯課件15頭面部的神經(jīng)阻滯課件16頭面部的神經(jīng)阻滯課件17頭面部的神經(jīng)阻滯課件18頭面部的神經(jīng)阻滯課件19頭面部的神經(jīng)阻滯課件20頭面部的神經(jīng)阻滯課件21頭面部的神經(jīng)阻滯課件22頭面部的神經(jīng)阻滯課件23頭面部的神經(jīng)阻滯課件24頭面部的神經(jīng)阻滯課件25頭面部的神經(jīng)阻滯課件26頭面部的神經(jīng)阻滯課件27頭面部的神經(jīng)阻滯課件28頭面部的神經(jīng)阻滯課件29頭面部的神經(jīng)阻滯課件30頭面部的神經(jīng)阻滯課件31頭面部的神經(jīng)阻滯課件32頭面部的神經(jīng)阻滯課件33頭面部的神經(jīng)阻滯課件34頭面部的神經(jīng)阻滯課件35頭面部的神經(jīng)阻滯課件36頭面部的神經(jīng)阻滯課件37頭面部的神經(jīng)阻滯課件38頭面部的神經(jīng)阻滯課件39頭面部的神經(jīng)阻滯課件40頭面部的神經(jīng)阻滯課件41頭面部的神經(jīng)阻滯課件42頭面部的神經(jīng)阻滯課件43頭面部的神經(jīng)阻滯課件44頭面部的神經(jīng)阻滯課件45頭面部的神經(jīng)阻滯課件46頭面部的神經(jīng)阻滯課件47頭面部的神經(jīng)阻滯課件48頭面部的神經(jīng)阻滯課件49頭面部的神經(jīng)阻滯課件50頭面部的神經(jīng)阻滯課件51頭面部的神經(jīng)阻滯課件52頭面部的神經(jīng)阻滯課件53頭面部的神經(jīng)阻滯課件54頭面部的神經(jīng)阻滯課件55頭面部的神經(jīng)阻滯課件56頭面部的神經(jīng)阻滯課件57頭面部的神經(jīng)阻滯課件58頭面部的神經(jīng)阻滯課件59頭面部的神經(jīng)阻滯課件60頭面部的神經(jīng)阻滯課件61頭面部的神經(jīng)阻滯課件62頭面部的神經(jīng)阻滯課件63頭面部的神經(jīng)阻滯課件64頭面部的神經(jīng)阻滯課件65頭面部的神經(jīng)阻滯課件66頭面部的神經(jīng)阻滯課件67頭面部的神經(jīng)阻滯課件68頭面部的神經(jīng)阻滯課件69頭面部的神經(jīng)阻滯課件70頭面部的神經(jīng)阻滯課件71頭面部的神經(jīng)阻滯課件72頭面部的神經(jīng)阻滯課件73頭面部的神經(jīng)阻滯課件74頭面部的神經(jīng)阻滯課件75頭面部的神經(jīng)阻滯課件76頭面部的神經(jīng)阻滯課件77頭面部的神經(jīng)阻滯課件78頭面部的神經(jīng)阻滯課件79頭面部的神經(jīng)阻滯課件80頭面部的神經(jīng)阻滯課件81頭面部的神經(jīng)阻滯課件82頭面部的神經(jīng)阻滯課件83頭面部的神經(jīng)阻滯課件84頭面部的神經(jīng)阻滯課件85頭面部的神經(jīng)阻滯課件86頭面部的神經(jīng)阻滯課件87頭面部的神經(jīng)阻滯課件88頭面部的神經(jīng)阻滯課件89頭面部的神經(jīng)阻滯課件90頭面部的神經(jīng)阻滯課件91頭面部的神經(jīng)阻滯課件92頭面部的神經(jīng)阻滯課件93頭面部的神經(jīng)阻滯課件94頭面部的神經(jīng)阻滯課件95頭面部的神經(jīng)阻滯課件96頭面部的神經(jīng)阻滯課件97頭面部的神經(jīng)阻滯課件98頭面部的神經(jīng)阻滯課件99頭面部的神經(jīng)阻滯課件100頭面部的神經(jīng)阻滯課件101頭面部的神經(jīng)阻滯課件102頭面部的神經(jīng)阻滯課件103頭面部的神經(jīng)阻滯課件104頭面部的神經(jīng)阻滯課件105頭面部的神經(jīng)阻滯課件106頭面部的神經(jīng)阻滯課件107頭面部的神經(jīng)阻滯課件108頭面部的神經(jīng)阻滯課件109頭面部的神經(jīng)阻滯課件110頭面部的神經(jīng)阻滯課件111頭面部的神經(jīng)阻滯課件112頭面部的神經(jīng)阻滯課件113頭面部的神經(jīng)阻滯課件114頭面部的神經(jīng)阻滯課件115頭面部的神經(jīng)阻滯課件116頭面部的神經(jīng)阻滯課件117頭面部的神經(jīng)阻滯課件118頭面部的神經(jīng)阻滯課件119頭面部的神經(jīng)阻滯課件120頭面部的神經(jīng)阻滯課件121頭面部的神經(jīng)阻滯課件122頭面部的神經(jīng)阻滯課件123頭面部的神經(jīng)阻滯課件124頭面部的神經(jīng)阻滯課件125頭面部的神經(jīng)阻滯課件126頭面部的神經(jīng)阻滯課件127頭面部的神經(jīng)阻滯課件128頭面部的神經(jīng)阻滯課件129頭面部的神經(jīng)阻滯課件130頭面部的神經(jīng)阻滯課件131頭面部的神經(jīng)阻滯課件132頭面部的神經(jīng)阻滯課件133頭面部的神經(jīng)阻滯課件134頭面部的神經(jīng)阻滯課件135頭面部的神經(jīng)阻滯課件136頭面部的神經(jīng)阻滯課件137頭面部的神經(jīng)阻滯課件138頭面部的神經(jīng)阻滯課件139頭面部的神經(jīng)阻滯課件140頭面部的神經(jīng)阻滯課件141頭面部的神經(jīng)阻滯課件142頭面部的神經(jīng)阻滯課件143頭面部的神經(jīng)阻滯課件144頭面部的神經(jīng)阻滯課件145頭面部的神經(jīng)阻滯課件146頭面部的神經(jīng)阻滯課件147頭面部的神經(jīng)阻滯課件148頭面部的神經(jīng)阻滯課件149頭面部的神經(jīng)阻滯課件150頭面部的神經(jīng)阻滯課件151謝謝46、我們?nèi)粢呀邮茏顗牡?/p>