요추 천자 후 관리 방법

1.1 자세와 몸의 위치

The ideal puncture position is to use the natural lateral recumbent position. The line connecting the patient's shoulders and the iliac crest is perpendicular to the operating table, the thighs are flexed toward the body, and the head and neck are flexed toward the chest, so that the spine can achieve the best flexion rate. The spinous processes are separated from each other. Assist the non-cooperator to fix the posture, especially to maintain a good posture when the needle is inserted, so as to improve the success rate of the puncture. During the operation, closely observe the complexion, consciousness, and breathing of the child. If there is any abnormality, report it to the doctor, stop the puncture, and deal with it accordingly.

1.2 수술 후 관리

1.2.1 누운 자세

아이의 상태에 따라 4~6시간 동안 베개를 벗은 채로 눕습니다. 베개 사용에 익숙하신 분들은 머리 뒤에 얇은 베개(두께 3~5cm)를 두어 목 근육을 풀어주세요. 또한 천자 후 등의 불편 함을 방지하기 위해 얇은 베개를 놓으십시오.

1.2.2 질병 관찰

체온, 맥박, 호흡, 혈압, 의식, 눈동자, 구토, 두통 등을 동적으로 모니터링하고 이상이 있으면 의사에게 적시에 보고합니다.

1.2.3 심리 치료

천자 전 심리치료가 이루어져야 하며, 부모의 걱정을 덜어주는 열쇠입니다. 전통적인 개념의 영향으로 인해 부모는 요추 천자에 대해 일정한 저항을 가지고 있으며 요추 천자 후 아이가 똑똑하지 않거나 요추 천자의 후유증을 남기지 않을까 두려워합니다. 따라서 부모의 이해를 바꾸고 걱정을 없애기 위해 자세한 설명을 제공합니다. , 긍정적인 태도와 언어로 아동이 치료에 협조하도록 영향을 미치고, 아동에게 나쁜 암시를 주거나 두려움을 증가시키지 않도록 합니다.

Do a good job of psychological counseling for children. Children's nervousness and fear of diagnosis and treatment are particularly prominent. Children receiving diagnosis and treatment should take targeted psychological care according to different ages. Explain clearly the purpose of the examination and the method of intraoperative cooperation to the older child, answer their questions patiently, give the child enough psychological support, explain it in affirmative language as much as possible, and praise the child for being a brave and obedient child. You can also try to let the child talk more, or give favorite toys to distract their attention. No matter before or after the puncture, the child should not be discussed or hinted about possible discomfort in order to reduce their fear. For children under the age of 3, because they cannot understand complex language, they should be more patient and talk to them kindly, so that they have a sense of closeness and dependence. During the puncture, the parents were accompanied by their side for psychological support, and the children were basically able to cooperate through the above measures.

2 증상 치료

2.1 요추 천자 후 두통에 대한 간호 중재

During the lumbar puncture procedure, if the puncture needle accidentally penetrates the dura mater and enters the subarachnoid space, it may cause the patient post{{0}}lumbar puncture headache (PLPHA). A considerable number of PLPHA patients suffer from headaches affecting their normal life and work, so this phenomenon has attracted widespread attention in the medical community. Xie Shuli and others took nursing interventions to prevent PLPHA with obvious effect. The main intervention measures are as follows: (1) Once the dura is penetrated, the epidural space is injected with warm (30 degree ) normal saline in the early stage, and the postoperative infusion is combined with analgesic drug treatment to relieve the headache. Place the patient in the "natural back position", that is, lying on the side, with the back in a natural comfortable position, with the hip and knee joints slightly bent, whichever can support the lateral position and facilitate puncture, instead of the excessively bent back position previously used, with To prevent the dura mater from being too tight and making the perforation larger, after dural puncture, withdraw the puncture needle by 0.5 cm until the outflow of cerebrospinal fluid stops completely, and inject 5 mL of warm normal saline into the epidural space to increase the pressure in the epidural space , reduce the leakage of cerebrospinal fluid. ②Strict aseptic operation and non-contact technology, in line with the principle of prevention, strictly disinfect the puncture equipment and the patient's skin, do not mix the local anesthetic liquid into the air or blood, and give active symptomatic treatment to patients who may have pseudomeningitis. Apply a small amount of sulfonamides. ③ Mild headache disappears after 2-3 days of bed rest. Acupuncture at Taiyang, Yintang, Hegu and other acupoints is used to relieve headache. ④ infusion to accelerate the formation of cerebrospinal fluid. If there is no obvious improvement, 10 mL-20 mL of warm normal saline or 5 percent dextrose saline should be injected into the epidural space at the puncture point to increase the pressure in the space and slow down the loss of cerebrospinal fluid.

2.2 요추 천자 후 요통의 간호

Some studies have shown that parents' bad suggestion is the main cause of low back pain in children, and children's nervousness and fear are an important factor in causing low back pain, and improper puncture posture damages ligaments and sarcolemma is another important reason. . Therefore, posture and body position during the entire lumbar puncture process, as well as psychological care before puncture, are important measures to reduce back pain after lumbar puncture. Before lumbar puncture, explain to parents or older children that lumbar puncture is one of the indispensable means of diagnosing the disease, and the diagnosis and treatment of the disease should not be delayed due to serious concerns. , that is, about 20 mL of cerebrospinal fluid can be produced per hour, and 2 mL of cerebrospinal fluid can be produced in about 10 minutes, which will not affect normal physiological functions. The purpose is to explain that the damage of lumbar puncture to the body is not large, so as to eliminate the ideological concerns of parents and older children, so as to timely check the lumbar puncture, achieve early diagnosis, early treatment and early recovery. Explain the whole process of lumbar puncture, and demonstrate the position of lumbar puncture, so that the patient can be placed in the correct position, and parents can be allowed to accompany the lumbar puncture during the operation, so as to reduce the tension and strangeness of the child. After the puncture, the patient should be placed in the supine position, and whether to lie down on the pillow for 4 to 6 hours depends on the patient's condition. For those who are used to pillows, put a thin pillow (3 cm to 5 cm thick) behind their head when lying down to relax the neck muscles, and also put a thin pillow on the back. This is the main measure to prevent low back pain after puncture.

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