1、腰穿提高篇医学知识专腰穿提高篇医学知识专题讲座题讲座腰穿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2腰穿提高篇医学知识专题讲座理想与现实是有差距的3腰穿提高篇医学知识专题讲座体位: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 ed
2、ge of the bed and the plane of the back and shoulders as perpendicular to the bed as possible.4腰穿提高篇医学知识专题讲座体位5腰穿提高篇医学知识专题讲座体位6腰穿提高篇医学知识专题讲座与床面的关系：两条垂直线，一条平行线8腰穿提高篇医学知识专题讲座间隙nDrawing an imaginary line between the two posterior iliac crests will allow identification of the L3-4 or L4-5 interspaces.9腰
3、穿提高篇医学知识专题讲座确定中点10腰穿提高篇医学知识专题讲座进针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.11腰穿提高篇医学知识专题讲座进针12腰穿提高篇医学知识专题讲座理想与现实还是有差距的13腰穿提高篇医学知识专题讲座进
4、针层次14腰穿提高篇医学知识专题讲座矢状面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
5、 between the nerve roots of the cauda equina(7).Lumbar vertebral bodies(9),intervertebral disc(10),and lumbar puncture needle(11).15腰穿提高篇医学知识专题讲座水平面nHorizontal section of lumbar vertebra illustrating the course of the lumbar puncture needle through skin(1),subcutaneous tissue(2),between the spinous
6、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).16腰穿提高篇医学知识专题讲座进针17腰穿提高篇医学知识专题讲座心理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18腰穿提高篇医学知识专题讲座总结19腰穿提高篇医学知识专题讲座参考文献nBoon JM,Abrahams PH,Meiring JH,et al.Lumbar puncture:anatomical review of a clinical skill.Clin Anat 2004;17(7):544-53.20腰穿提高篇医学知识专题讲座谢谢！21腰穿提高篇医学知识专题讲座
