淋巴引流.ppt

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1、soreha educationManual Lymph Drainage淋巴引流手法淋巴引流手法ContentsHistoryLymph systemPathologyMLDTreatmentCDTContents内容内容 History of Manual Lymph Drainage淋巴引流手法概述 Anatomy&Physiology of the Lymph System 淋巴系统解剖学分析 Pathology of the Lymph System淋巴系统病理学 Contraindications of Manual Lymph Drainage 徒手淋巴引流禁忌症 Princip

2、les of Manual Lymph Drainage 淋巴引流手法原则 Technique of Manual Lymph Drainage 淋巴引流手法技术 Treatment of Arm&Leg 手臂和腿部治疗 Complex Decongestion Therapy 综合性降充血治疗ContentsHistoryLymph systemPathologyMLDTreatmentCDTHistory of Manual Lymph Drainage手法概述手法概述 16th century:first descriptions of Lymph System十六世纪：首先对淋巴系统进

3、行了描述 MLD founded and developed in 1930s 上世纪30年代创立和发展 regular part of physiotherapy/physical therapy since 1970s上世纪70年代运用到临床治疗中 3 main different techniques of MLD 三种不同的技术Dr Vodders Manual Lymph DrainageVodder博士淋巴引流手法ContentsHistoryLymph systemPathologyMLDTreatmentCDTAnatomy&Physiology of Lymph System

4、淋巴系统解剖学知识淋巴系统解剖学知识 vascular system in completion to blood vessel system脉管系的组成部分，最终淋巴流入静脉 one way“system单向流动 transports lymph from periphery back to heart回流至心脏 function:evacuation of debris(proteins,bacteria,.)功能：清除和过滤（蛋白质，细菌，。）balance of filtration and resorption:maintenance of interstitial pressure

5、回收和过滤平衡：维持组织间液平衡ContentsHistoryLymph systemPathologyMLDTreatmentCDTAnatomy&Physiology of Lymph System淋巴系统解剖学知识淋巴系统解剖学知识 initial lymph vessel是淋巴管道的起始段 cover whole body surface 覆盖全身表面 glove-finger shaped,blind origing in the tissue膨大的盲端起始 overlapping endothelial cells管壁由单层内皮细胞构成windows:influx of inter

6、sitial fluid&lymph-obligatory substances组织液只能进不能出Lymph Capillaries毛细淋巴管ContentsHistoryLymph systemPathologyMLDTreatmentCDTAnatomy&Physiology of Lymph System淋巴系统解剖学知识淋巴系统解剖学知识Lymph Capillaries毛细淋巴管 anchor filaments 彼此吻合成网 function:absorption of interstitial fluid,generating lymph功能：收集细胞间隙液（组织液）称为淋巴液，

7、简称淋巴 lead into the precollectors汇合形成淋巴管ContentsHistoryLymph systemPathologyMLDTreatmentCDTAnatomy&Physiology of Lymph System淋巴系统解剖学知识淋巴系统解剖学知识Lymph Capillaries毛细淋巴管ContentsHistoryLymph systemPathologyMLDTreatmentCDTAnatomy&Physiology of Lymph System淋巴系统解剖学知识淋巴系统解剖学知识Precollectors淋巴管 few muscular tis

8、sue少量的肌肉组织 valves avoid reflux内瓣膜防止回流 function:generation and transportation of lymph功能：产生和运输淋巴液lead into the collectors 汇合形成淋巴干ContentsHistoryLymph systemPathologyMLDTreatmentCDTAnatomy&Physiology of Lymph System淋巴系统解剖学知识淋巴系统解剖学知识 Collectors淋巴干 above&below muscular fascia在肌肉筋膜上下 consist of lymphang

9、ions由淋巴管构成 built of muscular tissue&valves肌肉组织和瓣膜结构 internal pressure increases 内压增加 lymphangions contract reflectory淋巴管反射性收缩ContentsHistoryLymph systemPathologyMLDTreatmentCDTAnatomy&Physiology of Lymph System淋巴系统解剖学知识淋巴系统解剖学知识Central collectors淋巴导管 Ductus thoracicus胸导管Ductus lymphaticus 左导管/右淋巴导管

10、Vena subclavia left&right(venous angle)左右静脉角ContentsHistoryLymph systemPathologyMLDTreatmentCDTAnatomy&Physiology of Lymph System淋巴系统解剖学知识淋巴系统解剖学知识Lymph nodes淋巴结 are interposed into lymph vessel system在淋巴管行程的通路上 600 lymph nodes 600个淋巴结 function:biological filter,specific immune defense,regulation of

11、 protein and water concentration 功能：过滤淋巴液，免疫反应/免疫防御，调节蛋白质 和水的密度/浓度ContentsHistoryLymph systemPathologyMLDTreatmentCDTAnatomy&Physiology of Lymph System淋巴系统解剖学知识淋巴系统解剖学知识Drainage divides分水线ContentsHistoryLymph systemPathologyMLDTreatmentCDTAnatomy&Physiology of Lymph System淋巴系统解剖学知识淋巴系统解剖学知识Definitio

12、ns定义 lymph淋巴:content of lymphatic vessel淋巴管内液体 lymph-obligatory substances:all material,that must be transported by the lymphatic system强制性淋巴物质:淋巴循环系统中流动的所有物质 lymphangio-motor function:autonomous motor function,passive stretching,auxiliary pumps淋巴流动功能：自主运动功能，被动牵伸，辅助动力ContentsHistoryLymph systemPatho

13、logyMLDTreatmentCDTAnatomy&Physiology of Lymph System淋巴系统解剖学知识淋巴系统解剖学知识Transportation of Lymph 淋巴流动Diffusion弥散 particles move from places with higher concentration to places with lower concentration(molecular movement)由高浓度向低浓度渗入（分子运动）the longer the transit distance the more time is needed吸收距离越长，所需时间

14、越长Balance of concentration 间液浓度平衡ContentsHistoryLymph systemPathologyMLDTreatmentCDTAnatomy&Physiology of Lymph System淋巴系统解剖学知识淋巴系统解剖学知识Transportation of Lymph淋巴流动Diffusion弥散ContentsHistoryLymph systemPathologyMLDTreatmentCDTAnatomy&Physiology of Lymph System淋巴系统解剖学知识淋巴系统解剖学知识Transportation of Lymph

15、淋巴流动Osmosis渗透 2 fluids with different concentration seperated by semipermeable membrane被半透性的薄膜分离成两种浓度不同的液体solvent wanders in direction of higher concentration向高浓度方向溶解ContentsHistoryLymph systemPathologyMLDTreatmentCDTAnatomy&Physiology of Lymph System淋巴系统解剖学知识淋巴系统解剖学知识Transportation of Lymph淋巴流动Osmo

16、sis渗透ContentsHistoryLymph systemPathologyMLDTreatmentCDTAnatomy&Physiology of Lymph System淋巴系统解剖学知识淋巴系统解剖学知识Transportation of Lymph淋巴流动Transcytosis胞吞转运作用 active mode of transportation自主运输模式 proteins,fatty acids enter/exit cells through endo-and exocytosis蛋白质，脂肪酸进出内皮细胞，内吞作用，包裂外排/胞外分泌ContentsHistoryLy

17、mph systemPathologyMLDTreatmentCDTAnatomy&Physiology of Lymph System淋巴系统解剖学知识淋巴系统解剖学知识Transportation capacity运送容量 under physiological conditions the amount of lymph-obligatory substances corresponds to lymph-time-volume正常生理情况下可以使用淋巴-时间-体积表示淋巴的流量ContentsHistoryLymph systemPathologyMLDTreatmentCDTAnat

18、omy&Physiology of Lymph System淋巴系统解剖学知识淋巴系统解剖学知识Transportation capacity运输容量Safety-valve function瓣膜安全阀功能increased incoming lymph-obligatory substances摄入的淋巴物质增长 augmented lymph-time-volume相应的流量增高ContentsHistoryLymph systemPathologyMLDTreatmentCDTClassification of Edema水肿的分类水肿的分类Definition定义 consequenc

19、e of disproportion of leading to and leading away amounts of fluid内外液交换平衡破坏，导致体液积聚 abnormal amount of water in the tissue过多的水 is rather a symptom of an underlying disease than a diagnosis 引起水肿的原因有更多内在障碍导致ContentsHistoryLymph systemPathologyMLDTreatmentCDTClassification of Edema水肿分类水肿分类Dynamic edema

20、动态水肿 excess supply that exceeds transportation capacity of the healthy lymph system淋巴系统回流潜力增大/过多液体超过正常的健康淋巴系统的运输能力 high-volume insufficiency 高容量机能不全 low-protein edema 低蛋白水肿 e.g.:cardiac/renal insufficiency,famine edema心性水肿，肾源性水肿，营养不良性水肿ContentsHistoryLymph systemPathologyMLDTreatmentCDTClassificatio

21、n of Edema水肿分类水肿分类Lymphostatic edema淋巴滞留性水肿 morbid lymph vessel system does not manage to cope with the normal incoming amount of lymph淋巴管系统阻塞导致无法正常控制淋巴液的流量 low-volume insufficiency低容量机能不全 primary:malformation of the lymphatic system原发性，结构异常 secondary:(reversible)external or internal influences lead

22、 to an impairment of the lymph system继发性，内外因素影响 e.g.:inflammatory processes,trauma,post-surgical,exacerpation of lymph nodes after tumor感染，外伤，肿瘤ContentsHistoryLymph systemPathologyMLDTreatmentCDTClassification of Edema淋巴分类淋巴分类Lymphedema淋巴水肿 transportation capacity is decreased and the amount of lymp

23、h is increased运送容量降低，淋巴含量增高 safety-valve insufficiency瓣膜（安全阀）机能不全 load of lymph-obligatory substances to the interstitium lead to chronic proliferative inflammation间隙淋巴组织负荷增高导致慢性增生性炎症 e.g.:venous insufficiency静脉炎/静脉功能不全ContentsHistoryLymph systemPathologyMLDTreatmentCDTClassification of Edema水肿分类水肿分

24、类Stage of Latency潜伏期(yet)no swelling visible无明显肿胀 impending edema 浮肿（前期）clinical assumption of impaired transportation capacity临床评估受损后的运载量ContentsHistoryLymph systemPathologyMLDTreatmentCDTClassification of Edema水肿的分类水肿的分类Stage I 轻度 clinically apparent swelling临床表现为肿块 spontaneously reversible自发性可逆 d

25、ent can be impressed指压出现轻度凹陷，平复快 Stemmers sign negative 阴性ContentsHistoryLymph systemPathologyMLDTreatmentCDTClassification of Edema水肿分类水肿分类Stemmers sign stemmer表象 dorsal part of the toes:size of the skin fold at the proximale phalanx 2mm脚趾背面：近指骨端皮肤收拢褶皱尺寸大于2mmContentsHistoryLymph systemPathologyMLDT

26、reatmentCDTClassification of Edema水肿分类水肿分类Stage II 中度 not spontaneously reversible无自发性可逆 dent can hardly be impressed明显凹陷，平复慢 Stemmers sign often positive阳性 no pain,no skin alterations无痛，皮肤无变化ContentsHistoryLymph systemPathologyMLDTreatmentCDTClassification of Edema水肿分类水肿分类Stage III 重度 elephantisias

27、tic augmentation of volume强化作用增加 hard consistency of tissue 平衡缺失 Stemmers sign positive 阳性 possibly pain 可能出现痛疼 skin alterations:hyperceratosis,pachydermia,possibly lymph fistels皮肤：厚皮出现，淋巴液外渗 irreversible不可逆ContentsHistoryLymph systemPathologyMLDTreatmentCDTManual Lymph Drainage淋巴引流手法淋巴引流手法Indicatio

28、ns指症 lymphostatic edema淋巴滞留性水肿 lymphedema淋巴水肿ContentsHistoryLymph systemPathologyMLDTreatmentCDTManual Lymph Drainage淋巴引流手法淋巴引流手法Contraindications禁忌症 relative:thyroidal diseases(treatment of neck),bronchial asthma,hypotonus相对：甲状腺障碍（治疗喉部），支气管哮喘，张力减退 absolute:malign tumors,acute infections/inflammatio

29、n,acute state of erysipelas,acute thrombosis,decompensated cardiac insufficiency绝对：恶性肿瘤，严重的感染和炎症，严重的丹毒，严重的血栓，心功能失调机能不全ContentsHistoryLymph systemPathologyMLDTreatmentCDTManual Lymph Drainage淋巴引流手法淋巴引流手法Effectiveness效用 deferral of fluids:due to abbreviation of transit distance increase of lymph angio

30、 motor function推压体液：缩短间距，有效排液改善和增加淋巴造影运动机能ContentsHistoryLymph systemPathologyMLDTreatmentCDTManual Lymph Drainage淋巴引流手法淋巴引流手法 increase of lymph angio motor function增加淋巴循环机能Collectors in the subcutis皮下淋巴导管组织alteration of pressure挤压Stretch lengthways/Crossways延伸和交叉牵伸淋巴管的搏动率pulsation rate of lymphangi

31、ons 淋巴流动Lymph flow ContentsHistoryLymph systemPathologyMLDTreatmentCDTManual Lymph Drainage淋巴引流手法淋巴引流手法Effectiveness效用 softening of fibrosis软化纤维化 sympathicolysis 抗交感神经 pain relief 镇痛ContentsHistoryLymph systemPathologyMLDTreatmentCDTManual Lymph Drainage淋巴引流手法淋巴引流手法Principles原则 light working pressur

32、e:fly,wasp would be too much推压手法轻柔：？changing working pressure(pressure phase/zero phase)改变力度（挤压阶段/零用力阶段）monotony一致性ContentsHistoryLymph systemPathologyMLDTreatmentCDTManual Lymph Drainage淋巴引流手法淋巴引流手法Principles原则 moving the skin NOT gliding over it 不要使皮肤发生褶皱 spiral or circular grips螺旋或者圆形抓握 constant,

33、rhythmic grips不间断有节律的抓握 grips must not cause pain or redness不要引起疼痛或者充血 direction of pressure according to direction of lymph flow挤推方向遵循淋巴流动方向ContentsHistoryLymph systemPathologyMLDTreatmentCDTManual Lymph Drainage淋巴引流手法淋巴引流手法Principles原则 maximum skin contact to move large area of the skin最大面积接触皮肤 us

34、ually working on dry skin(no oil,lotion)通常作用于干燥的皮肤（无油，护肤液）treatment always starts with(short)preparing treatment of the neck治疗总是从短暂的颈部治疗准备开始ContentsHistoryLymph systemPathologyMLDTreatmentCDTManual Lymph Drainage淋巴引流手法淋巴引流手法Stationary circle 静止圆123ContentsHistoryLymph systemPathologyMLDTreatmentCDTM

35、anual Lymph Drainage淋巴引流手法淋巴引流手法Pump Technique压送手法123ContentsHistoryLymph systemPathologyMLDTreatmentCDTManual Lymph Drainage淋巴引流手法淋巴引流手法Scoop Technique铲形技术1a1b2345ContentsHistoryLymph systemPathologyMLDTreatmentCDTManual Lymph Drainage淋巴引流手法淋巴引流手法Rotary Technique旋转技术12345ContentsHistoryLymph system

36、PathologyMLDTreatmentCDTManual Lymph Drainage淋巴引流手法淋巴引流手法Thumb circle拇指画圆1234ContentsHistoryLymph systemPathologyMLDTreatmentCDTContentsHistoryLymph systemPathologyMLDTreatmentCDTComplex Decongestive Therapy综合降充血治疗综合降充血治疗 Manual Lymph Drainage 淋巴引流手法 bandage绷带 skin care 皮肤护理 active exercises 主动运动 code of behaviour 行为准则Thank you谢谢soreha education