腰椎穿刺は何に注意を払うべきですか？

腰椎穿刺と注意事項

（1）操作：

① Explain the purpose and precautions of puncture to the patient, eliminate tension and fear, obtain cooperation, and ask to urinate.

② Do a procaine skin test before surgery, prepare all the supplies, bring it to the patient's bed, and cover it with a screen

③ The patient lies on the side of the hard board bed, removes the pillow, puts the back on the edge of the bed, spreads rubber towels and therapeutic towels, bends the head to the chest, tucks the knees with both hands, bends the knees to the abdomen, and arches the back as far as possible. The intervertebral space is widened, which is favorable for puncture.

④Assist the patient to fix the posture during puncture and avoid movement to prevent the needle from breaking, especially for children.

⑤ The puncture site generally takes 3 to 4 lumbar intervertebral spaces, and the vertebral spine line connecting the iliac vertebrae on both sides is the 3rd lumbar intervertebral space.

⑥ The puncture site is strictly disinfected. The operator wears sterile gloves, drapes a hole towel, and uses 2 percent procaine for local infiltration anesthesia.

⑦ The operator holds the lumbar puncture needle (with the needle core) and inserts the needle vertically along the lumbar intervertebral space. When the needle is advanced to a depth of 4 to 6 cm (2 to 3 cm for children), the resistance suddenly disappears, indicating that the needle has entered the meningeal cavity. Pull out the needle core, and the cerebrospinal fluid will flow out automatically. At this time, let the patient relax the whole body, breathe calmly, stretch the lower limbs and head slightly, connect the pressure tube, and the liquid level can be seen to rise slowly. After reaching a certain level, it can be seen that the liquid level fluctuates with breathing. , this reading is the cerebrospinal fluid pressure; if the pressure is significantly increased, the needle core cannot be completely pulled out, so that the cerebrospinal fluid drips slowly to prevent the formation of brain herniation.

⑧ During the puncture process, pay attention to observe the changes of the patient's consciousness, pupil, pulse, and breathing. If the condition changes, immediately report to the doctor to stop the operation and assist in rescue.

⑨ It is necessary to know whether the subarachnoid space is blocked or not, and a dynamic test (also known as a neck pressure test) can be performed. That is, after measuring the initial pressure, compress the patient's side jugular vein for 10 seconds to observe and judge.

A.首の圧迫直後に脳脊髄液圧が元のレベルの1倍に上昇し、圧迫が緩和されてから20秒以内に元のレベルに急速に低下する場合は、くも膜下腔が塞がれていないことを示しています。

B.首を押しても脳脊髄液圧が上昇しない場合は、くも膜下腔が完全に塞がれていることを示しています。

C.首を押した後、脳脊髄液の圧力がゆっくりと上昇し、圧力が解放された後、ゆっくりと低下するか、または低下しない場合は、くも膜下腔が完全に塞がれていないことを示しています。

⑩ Take 3-5ml of cerebrospinal fluid and send it to a sterile test tube. For bacterial culture, the mouth of the sterile test tube should be sterilized by an alcohol flame to receive the cerebrospinal fluid, and then the mouth and cotton plug should be sterilized by an alcohol lamp flame and then covered with a cotton plug. If needed for intrathecal injection, inject the liquid slowly.

⑾ Insert the needle core after the operation, pull out the lumbar puncture needle, disinfect the needle hole with iodine, cover it with sterile gauze, and fix it with tape. Do not wet the puncture site for 1 week.

⑿ Clean up the sheets and supplies, record the volume, color, and nature of cerebrospinal fluid, and send the collected specimens for testing immediately.

（2）注：

①After the puncture, make the patient lie down on the pillow for 4-6 hours, and those with high intracranial pressure lie down for 12-24 hours. Continue to observe the patient's condition and the presence or absence of headache, nausea, low back pain and other reactions.

②Prevent low{{0}}pressure headache, which is mainly caused by the puncture needle being too thick or getting up too early or the leakage of cerebrospinal fluid from the puncture hole. The headache aggravates when the patient is standing, relieves after lying down, disappears after 1 to 3 days, and can reach 7 to 0 days in the elderly. Once it occurs, the patient should lie down, drink more saline, or intravenously drip 500-1000ml of normal saline, or add pituitary hormone to promote the secretion of cerebrospinal fluid.

③In patients with increased intracranial pressure, lumbar puncture should not be performed to avoid sudden changes in the dynamics of cerebrospinal fluid, unbalanced pressure between the cranial cavity and spinal cavity, resulting in the formation of brain herniation.

④ If there is purulent infection at the puncture site, puncture is prohibited to avoid subarachnoid infection.

⑤ For intrathecal injection of drugs, an equal amount of cerebrospinal fluid should be released, and the drug should be balanced with normal saline, and the injection should be very slow.

⑥ If symptoms of brain herniation appear during the puncture process (such as unequal pupil size, unconsciousness, abnormal breathing), the fluid should be stopped immediately, and air or normal saline (10-12ml) should be injected into the spinal canal for hydrostatic injection. 20 percent Mannitol 250ml.

⑦ For those who are restless and unable to cooperate, it can be performed under sedative or basic anesthesia, and special assistance is required.

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