循证护理在腰椎穿刺术后体位护理中的应用

我科运用循证护理知识,通过改变患者卧位,加强观察与沟通,对观察组48例腰椎穿刺术后患者进行护理,取得较好效果。现报告如下。1资料及方法1.1一般资料选择2012-01—10我科96例住院患者,按腰椎穿刺的先后顺序随机分为观察组和对照组各48例,观察组男28例,女20例;对照组男26例,女22例;2组患者年龄14～67岁,平均(45.7±9.5)岁,均为第1次腰椎穿刺,无     

改良小儿腰椎穿刺术300例临床分析

目的 观察应用改良小儿腰椎穿刺术行腰椎穿刺的临床效果.方法 对传统小儿腰椎穿刺方法进行改进:(1)以一次性无菌注射针为穿刺针;(2)镇静:<7岁及≥7岁评估难以配合者,使用安定镇静;(3)不做麻醉.将600例患儿随机分为传统方法组和改良方法组各300例,观察和比较传统方法组和改良方法组的临床效果、穿刺成功率,术后并发症发生率及患儿配合情况.结果 传统方法组总成功率79%(一次性成功率61.3%);改良方法组总成功率90.3%(一次性成功率83.7%),2组比较差异有统计学意义(P<0.05).并发症发生率:传统方法组中头痛为6.5%,副损伤为14%,腰背痛为13.6%;改良方法组中头痛为2%,副损伤为5.7%,腰背痛为5.8%,2组各项比较差异均有统计学意义(P<0.05).结论 改良小儿腰椎穿刺术明显提高腰椎穿刺成功率.并发症发生率低,减少患儿痛苦及紧张,配合程度高,操作易行,值得临床推广.     

腰椎穿刺术在特发性正常压力脑积水治疗中的应用

目的探讨腰椎穿刺技术在老年人特发性正常压力脑积水治疗中的应用价值。方法回顾性分析54例特发性正常压力脑积水患者的临床资料。结果本组43例患者术后均得到6—12月随访,显效25例;有效18例;本组43例腰椎穿刺脑脊液放液试验症状改善患者手术有效率100％,术后患者步态障碍、尿失禁改善明显,智能障碍均有不同程度改善,影像学检查见脑室系统有不同程度缩小。结论腰椎穿刺放液试验是筛选特发性正常压力脑积水及预测手术疗效的有效方法。     

对椎旁腰椎穿刺术的验证

腰椎穿刺是诊断和治疗疾病的重要手段.但在临床实际工作中,我们常因患者椎间韧带钙化,腰椎畸形等原因按一般腰椎穿刺术方法确有困难或无法实施。我院自1996—07～2004—12对71例蛛网膜下腔出血患者，均采用庞亚东等撰写的椎旁腰椎穿刺术方法，行脑脊液置换495人次，均获得成功。此法无一人次外伤出血和其他不良反应。现介绍椎旁腰椎穿刺术如下。     

重型颅脑损伤去骨板减压术后早期腰椎穿刺术与继发性脑积水的关系

目的 探讨早期腰椎穿刺术（LP）预防重型颅脑损伤（STBI）去骨板减压术后继发性脑积水的效果。方法 回顾性分析2010年6月至2013年6月收治的107例STBI患者的临床资料,均行开颅去骨瓣减压术,术后早期LP治疗48例（LP组）,未给予LP干预59例（对照组）。结果 LP术后5例（10.4%）发生脑积水,其中急性脑积水2例（4.2%）,亚急性脑积水2例（4.2%）,慢性脑积水1例（2.1%）。对照组术后22例（37.3%）发生脑积水,其中急性脑积水11例（18.6%）,亚急性脑积水10例（16.9%）,慢性脑积水1例（1.7%）。两组脑积水总发生率、急性脑积水发生率和亚急性脑积水发生率均有统计学差异（P<0.01）。>结论 STBI患者去骨板减压术后早期辅以LP可有效降低术后急性脑积水和亚急性脑积水的发生率,而对慢性脑积水的无明显影响。     

虚拟现实联合模拟人教学模式在腰椎穿刺术技能培训中的应用

目的 探讨虚拟现实（virtualreality,VR）联合模拟人教学模式在医学实习生腰椎穿刺术教学中的培训效果。方法 选取空军军医大学第二附属医院轮转的医学本科实习生30名,随机将其分为VR组、模拟人组、VR联合模拟人组各10名。首先进行1个学时的理论教学,然后VR组进行2个学时的VR腰椎穿刺术培训,模拟人组进行2个学时的模拟人腰椎穿刺术培训,VR联合模拟人组各进行1个学时的VR和模拟人腰椎穿刺术培训。培训后评估腰椎穿刺术理论,并进行实践操作技能考核。通过问卷调查,收集学生对VR腰椎穿刺术培训的主观评价。结果 培训后,VR联合模拟人组的理论成绩高于模拟人组[（80.4±5.0）分vs.(69.5±9.0)分,P=0.005],实践技能成绩高于模拟人组[（86.4±4.2）分vs.(79.8±3.5)分,P=0.004]和VR组[（86.4±4.2）分vs.(81.3±4.6)分,P=0.028]。调查问卷显示,90%左右的实习生认为VR腰椎穿刺术培训可以有效提高学习兴趣和实践能力。结论 VR腰椎穿刺术培训可有效提高腰椎穿刺的教学效果,VR联合模拟人的教学效果优于单独VR或模拟人的教学...     

7号注射针在小婴儿腰椎穿刺术中应用

腰椎穿刺术（简称腰穿）是儿科常见的临床诊疗操作方法之一，在小儿中枢神经系统疾病的诊断及治疗中起着重要作用。本科自2003年1月至今，用7号注射针头代替传统腰穿针对小婴儿进行腰椎穿刺术350例，取得良好效果，现总结如下。     

腰椎穿刺后头痛的研究进展

腰椎穿刺（简称腰穿）后头痛是临床常见的并发症，各家报道不一，发病率为2%—11%。自1898年德国医生Bier K首次用腰穿进行脊髓麻醉以来，腰穿已广泛用于临床诊断和治疗。尽管近年来对腰穿的方法学进行许多改进，减少了头痛的发生，但对腰穿后头痛的发生机制不明，有关腰穿后头痛的预防和治疗存在争议。本文就腰穿后头痛的发病机制、预防和治疗进展作一综述，与同道共享。     

腰椎穿刺术后低枕卧位300例临床观察

我科于2006-11～2007-03对300例腰穿病人术后2种卧位方法进行观察比较,现将结果报告如下. 1 临床资料 1.1 一般资料 2006-11～2007-03神经内科腰椎穿刺术病人300例,年龄8～17岁,平均14岁;男162例,女138例;清醒者200例,昏迷者100例.腰穿前身体受压部位皮肤正常.     

Paradoxical transtentorial herniation caused by lumbar puncture after decompressive craniectomy

Although decompressive craniectomy is an effective treatment for various situations of increased intracranial pressure, it may be accompanied by several complications. Paradoxical herniation is known as a rare complication of lumbar puncture in patients with decompressive craniectomy. A 38-year-old man underwent decompressive craniectomy for severe brain swelling. He remained neurologically stable for five weeks, but then showed mental deterioration right after a lumbar puncture which was performed to rule out meningitis. A brain computed tomographic scan revealed a marked midline shift. The patient responded to the Trendelenburg position and intravenous fluids, and he achieved full neurologic recovery after successive cranioplasty. The authors discuss the possible mechanism of this rare case with a review of the literature.     

Natural history of headache in patients with lymphocytic meningitis following lumbar puncture

BackgroundAnalysis of cerebrospinal fluid (CSF) obtained by lumbar puncture (LP) is essential for diagnosis of meningitis. What is the impact of the procedure upon the natural history of headache and associated signs in patients with lymphocytic meningitis and what factors can have prognostic value for the future progression of symptomatology? This study was aimed at looking into these questions.MethodsOne hundred and one patients with clinical and laboratory diagnosis of aseptic meningitis answered a questionnaire intended at assessing the severity and nature of headache and meningeal irritation signs before and one, and twenty four hours after the LP. Later they were divided into three groups according to presence and type of headache after 24 h. Demographic and clinical data was obtained from patients files.ResultsThere was almost 50% improvement in headache severity and associated signs after 24 hours from LP in the whole group of patients. Patients that did not have pain after 24 hours had higher BMI and lower headache severity one hour after LP compared to patients in the other groups (p = 0.064 and p = 0.005). Patients with papilledema had higher incidence of post dural puncture headache (PDPH).ConclusionsOur study shows that patients with aseptic meningitis undergo improvement in all parameters of headache and also in signs of meningeal irritation following LP. Higher BMI and low headache intensity are positive prognostic factors for improvement of headache after 24 hours while papilledema is associated with a higher incidence of PDPH.     

Effect of pregabalin on post-dural-puncture headache following spinal anesthesia and lumbar puncture

In this study, we aimed to investigate the effect of pregabalin on post-dural-puncture headache (PDPH). Forty patients who developed PDPH after spinal anesthesia or diagnostic and/or therapeutic lumbar puncture were divided into two groups and followed for 5 days. The first group received 150 mg/day oral pregabalin for the first 3 days, then 300 mg/day for a further 2 days. The second group received a placebo for the same length of time. Patient headaches were scored using the visual analog scale, and diclofenac sodium and pethidine requirements were recorded. Relative to the placebo group, the group administered pregabalin had significantly lower visual analog scale scores after the second day of treatment, and had significantly lower diclofenac sodium requirements. Our results indicate that pregabalin may be useful for the management of PDPH.     

比阿培南联合腰穿治疗开颅术后颅内感染的疗效及安全性分析

目的分析比阿培南联合腰穿治疗神经外科开颅术后颅内感染患者的疗效及安全性。方法将40例神经外科开颅术后颅内感染患者分为治疗组和对照组各20例。治疗组使用比阿培南联合腰穿治疗,对照组使用头孢吡肟联合腰穿治疗,分别观察2组治疗前后体温(T)、白细胞总数(WBC)、脑脊液有核细胞数(TC-BF)、脑脊液葡萄糖(GLU)、脑脊液总蛋白(TPC3)、药物不良反应及实验室检查结果。结果治疗组总有效率95.0%(19/20),对照组为85.0%(17/20);2组治疗后体温均有明显改变,血液及脑脊液相关指标(WBC、TC-BF、GLU、TPC3)治疗前后均有显著改善(P0.05),但治疗组临床有效治疗时间优于对照组(P0.05);2组治疗前后药物不良反应及实验室检查结果差异有统计学意义(P0.05)。结论比阿培南联合腰穿治疗神经外科开颅术后颅内感染患者可显著改善患者的血液及脑脊液指标,比头孢吡肟联合腰穿治疗时间明显缩短,不良反应少。     

Is obligatory bed rest after lumbar puncture obsolete?

Summary After lumbar puncture (LP) an epidural CSF leakage caused by delayed closure of a dural defect leads to a decrease in CSF pressure. The resultant venous dilatation as well as downward shift of the brain with traction on pain-sensitive blood vessels and nerves frequently evokes post-lumbar puncture headache (PLPH), when the patient assumes the upright position. In previous studies differing opinions have been expressed about the prophylactic value of the posture taken by the patient after LP. The present study was designed to evaluate the benefit of the decrease of hydrostatic CSF pressure on the dural rent, when the patient lies down in a prone position with the head tilted down at an angle of 10° for 30 min immediately after LP: is it possible to accelerate the closure of the dural defect in this way and prevent PLPH? One group of patients (n = 78) lay in a prone position with the head tilted down at an angle of 10° for 30 min, the other group (n = 82) rose immediately after LP. PLPH was found to be independent of the posture in both groups and affected 44% and 41% of the patients, respectively, so that there is no longer any justification for requiring patients to remain in bed after LP.     

腰穿术后平卧方法的临床观察

目的 通过腰穿术后病人平卧方法舒适度的临床观察比较,从而探讨选择术后最佳的平卧方法.方法 观察并记录2001-02～2006-09的1070例门诊腰穿术后病人,2种平卧方法(即去枕仰卧位和低枕卧位)的舒适度.结果 随机分2组2种平卧方法临床观察,低枕卧位明显优于去枕仰卧位.结论 腰穿术后低枕卧位方法的选择对病人术后的尽快恢复,有较好的帮助.     

Postdural puncture headache leads to clinical worsening of pre-existing chronic headache

The incidence of postdural puncture headache (PDPH) in relation to pre-existing chronic headache (CH) was assessed, as was the clinical course of CH, at one, three, and six months after PDPH.The study was conducted as a single center cohort prospective study that included 252 patients (105 men and 147 women), average age of 47.3 ± 15.0 years, on whom lumbar puncture (LP) was performed.PDPH was reported in 133 (52.8%) patients; CH was reported in 82 (32.5%) patients. Patients with CH were more likely to have PDPH (p = 0.003). The individual clinical type of CH did not have an effect on the incidence of PDPH (p = 0.128). Patients with PDPH had a clinical deterioration of CH three and six months after LP (p = 0.047, p = 0.027, respectively) in terms of increased headache days per month and/or incomplete efficacy of performed therapy in relation to baseline values. Six months after LP, the worsening of CH was more common in women with PDPH (OR 5,687 [95% CI: 1526–21,200], p = 0.010) and patients with a longer history of CH (OR 1064 [95% CI: 1007–1124], p = 0.027). Multivariate analysis confirmed the direct association of female sex and duration of CH and its worsening six months after PDPH (OR 4478 [95% CI: 1149–17,452], p = 0.031; OR 1448 [95% CI: 1292–1808], p = 0.022).The presented results could be significant for the prediction/differential diagnosis of PDPH in patients with CH and for the prediction/prevention of CH clinical worsening after PDPH.     

Spinal coning after lumbar puncture in a patient with undiagnosed giant cervical neurofibroma

Lumbar puncture in the presence of an intracranial tumor with raised intracranial pressure is known to have catastrophic consequences due to herniation of intracranial contents through the tentorial hiatus or foramen magnum. There are relatively few case reports about the same sequence of events when lumbar puncture is performed below the level of a complete spinal block. The mechanism of such deterioration is also subject to conjecture as the spinal cord (unlike the uncus or cerebellar tonsils) is tethered by the dentate ligament and roots on either side, and is hence less mobile. We present one such case of spinal coning and review the available literature.     

非交通性脑积水神经内镜术后腰椎穿刺的重要性

目的探讨非交通性脑积水病人在神经内镜下行第三脑室底造瘘术(ETV)后腰椎穿刺的重要性。方法回顾性分析39例非交通性脑积水病人ETV术后的临床资料,均表现为颅高压;根据年龄分为儿童组(34例)和成人组(5例),均隔日一次行腰椎穿刺,测量和记录颅内压变化。结果儿童组ETV后早期颅内压降至正常范围后持续升高,于第3天达高峰,其后呈下降趋势,于第11天恢复正常;成人组ETV后早期颅内压明显降低后逐渐升高,第5天达高峰,余变化趋势同儿童组。两组各时间点腰椎穿刺初、末压差别均有统计学意义(P<0.05)。随访1年,儿童组腰椎穿刺治疗有效31例,无效3例;成人组腰椎穿刺治疗有效4例,无效1例。腰椎穿刺治疗无效的4例病人均再次行脑室-腹腔分流术。结论 ETV后腰椎穿刺有利于蛛网膜下腔和蛛网膜颗粒的开放,减少脑脊液流动阻力,提高其顺应性和缓冲能力,重建脑脊液循环。