肝脏穿刺术后患者最佳卧床时间探讨

目的探讨肝穿刺患者术后最佳的卧床时间。方法将138例肝穿刺患者随机分为观察组和对照组各69例,术后对照组患者按常规绝对卧床24 h,观察组患者绝对卧床6 h、24 h内避免剧烈运动。比较两组患者并发症发生情况及舒适情况。结果两组患者术后并发症发生率比较,差异无统计学意义(均P0.05),观察组舒适度明显优于对照组(均P0.05)。结论肝穿刺术后患者绝对卧床休息6 h,可提高患者舒适度,在临床上是安全可行的。     

卧床时间对腰椎穿刺术后头痛的影响研究

卧位腰椎穿刺术（以下简称腰穿）后，需去枕平卧4～6小时，以防止术后头痛的发生，这是国内科教书数十年不变的规定。但国际上存在相反的观点，认为腰穿后卧床时间过长会给医患双方带来诸多不便。本研究采用腰穿后去枕平卧（仰卧）30分钟和4小时作对比研究，以观察不同卧床时间对腰穿后头痛的影响。     

腰椎穿刺术后不同卧床时间对病人头痛影响研究

[目的]分析不同卧床时间对腰椎穿刺术(腰穿)后病人头痛影响程度.[方法]将680例腰穿病人随机分为30 min组、2 h组、4 h组和6 h组;4组均采取侧卧位,穿刺点选择腰椎第3间隙～第4间隙,使用9号穿刺针,留取脑脊液均为3 mL;30 min组留取脑脊液后去枕平卧30 min后起床活动,其他各组在留取脑脊液后去枕平卧术后去枕平卧30 min后采取自由卧位进行到相应时间后起床活动.[结果]4组病人腰穿后去枕平卧相应时间后在头痛及不舒适发生率方面差异均无统计学意义(均P>0.05),显示不同卧床时间对病人头痛及不舒适的影响较小.[结论]腰穿后卧床时间长短(30 min至6 h)对头痛的发生率无显著影响,故腰穿术后病人需要去枕平卧30 min后,可根据自身情况下床活动或者以自由体位继续卧床2 h ～6 h.     

经股动脉介入术后患者体位及卧床时间的循证实践

目的 将经股动脉介入术患者术后体位及卧床时间的最佳证据应用于临床护理实践,以减轻患者术后因长时间卧床所带来的并发症,提高患者术后舒适度及护理质量。方法 以JBI证据应用模式进行经股动脉术后体位及卧床时间的相关证据检索,并运用卫生保健中心证据分级（2014版）作为评估检索文献质量的标准,结合GRADE系统证据降级或升级因素确定证据等级,按照JBI FAME方法判断证据实施的可行性、适宜性、临床意义、有效性4个方面,并结合证据的JBI推荐强度确定推荐级别。将采纳的证据转化为临床审查指标,通过查看护理记录单、手术记录单、现场查看、问卷调查的方式收集资料,比较证据应用前（2020年7月—2021年1月,n=42）和应用后（2021年2—9月,n=40）经股动脉介入术后患者的舒适度、腰背部疼痛率及患者术后并发症情况。结果 证据应用后,经股动脉介入术后患者舒适度评分高于证据应用前;术后患者腰背部疼痛评分低于证据应用前,组间比较差异具有统计学意义（P<0.05）;证据应用前和证据应用后的术后并发症发生率比较,差异无统计学意义（P>0.05）。结论基于最佳证据将经股动脉介入术患者术后体位和...     

脑血管造影术后卧床时间对并发症的影响

目的 探讨脑血管造影术后卧床时间对并发症的影响.方法 将120例经股动脉穿刺脑血管造影的患者通过随机抽样法分为两组.现察组患者采用沙袋压迫穿刺局部6h,之后患者可左右移动或取侧卧住,静卧12h后可行下床旁活动.对照组术后常规沙袋压迫穿刺局部6h,患肢制动12h,静卧24h.观察并比较两组卧床时间对并发症发生的影响.结果 两组患者术后穿刺部位并发症伤口出血率比较无统计学意义,但术后排尿困难、羼背部疼痛、失眠、腹胀等非穿刺部位并发症比较有统计学意义(P<0.01).结论 应用循征方法改进后的护理方法显著降低了术后并发症的发生.     

肝癌介入术后卧床时间的循证研究

目的 探讨肝癌介入治疗术后患者的卧床体位对患者舒适度、并发症及不良反应的影响.方法 选择76例肝癌介入治疗患者,随机分为观察组和对照组各38例.对照组采用常规护理,观察组采用循证的方法研究肝癌介入术后的最佳卧床时间,对2组进行比较,探讨循证研究对患者的卧床时间、舒适度、并发症及术后胃肠道不良反应的影响.结果 观察组患者的实际卧床时间4～8 h;对照组为8 h以上.对照组患者的穿刺部位出现局部淤血1例,为患者肥胖自觉包扎过紧所致;局部血肿2例,为反复穿刺拔管加压不理想所致.观察组患者未见明显局部淤血和局部血肿.观察组的舒适度明显优干对照组.观察组患者术后胃肠道不良反应发生情况明显少于对照组.结论 采用循证研究,可以缩短患者的卧床时间,改善患者的舒适度和术后胃肠道不良反应,值得在临床上推广.     

冠状动脉介入治疗术后卧床时间的循证研究

目的通过运用循证护理,找出冠状动脉介入术后最佳的卧床时间。方法将60例冠状动脉成形术＋支架植入术患者作为实验组,术后4～6h拔管并徒手按压30min,2kg沙袋压迫穿刺点、卧床并制动6h后进行床上活动,24h后床旁活动。另60例作为对照组,除卧床并制动24h外,余同实验组。结果两组患者术后24h均有1例发生穿刺点出血、血肿。但实验组无1例需导尿,腹胀、排尿困难、腰酸、失眠的发生率也明显少于对照组。结论应用循证护理找出冠状动脉治疗术后最佳的卧床时间,并通过临床实践,表明改进后的护理方法可以显著降低术后并发症的发生,充分体现以人为本的护理理念。     

两种体位对腰椎穿刺术后患者的影响

腰椎穿刺（下称腰穿）是临床上脑部疾病患者诊疗中常用的重要手段之一，而术后卧位和翻身时间的长短影响到患者舒适度改变及压疮等并发症的发生。本文对2003年9月至2008年7月106例腰穿术后患者两种卧位方法进行了比较观察，现报道如下。     

改良的腰椎穿刺术

腰椎穿刺术是诊断神经系统疾病的必要手段,为了增加椎间隙距离,以往常规的穿刺方法是让患者头部向前层曲,贴近胸部,两腿层曲至腹部,使躯干部弯曲如弓状,这种方式不能适应病情危重或脊柱、下肢畸形的病人。1985年以来,我们对48例病人采用直体式腰椎穿刺术,取得满意效果。     

老年患者腰椎穿刺后两种卧位的效果对比

目的探讨提高老年患者腰穿术后舒适且又安全的合适卧位。方法将符合条件的64例老年患者随机分成两组:对照组(34例)患者腰穿术后采取去枕平卧4~6 h;观察组(30例)患者术后6 h内可左右交替侧卧或平卧,但避免坐起、抬高床头。观察两组患者出现头痛、腰背酸痛、皮肤压红及血压升高的情况。结果两组患者头痛的发生率及程度无统计学差异(P>0.05);而观察组患者出现腰背酸痛、皮肤压红的程度及术后4 h和6 h血压升高的例数均低于对照组(P<0.05)。结论老年患者腰穿术后6 h采取行左右交替侧卧或平卧的改良方式,既能保证患者的安全、减少不良反应,又能满足其生理需求,提高舒适度。     

老年患者腰椎穿刺后两种卧位的效果对比

目的探讨提高老年患者腰穿术后舒适且又安全的合适卧位。方法将符合条件的64例老年患者随机分成两组：对照组（34例）患者腰穿术后采取去枕平卧4～6h；观察组（30例）患者术后6h内可左右交替侧卧或平卧，但避免坐起、抬高床头。观察两组患者出现头痛、腰背酸痛、皮肤压红及血压升高的情况。结果两组患者头痛的发生率及程度无统计学差异（P〉0．05）；而观察组患者出现腰背酸痛、皮肤压红的程度及术后4h和6h血压升高的例数均低于对照组（P〈0．05）。结论老年患者腰穿术后6h采取行左右交替侧卧或平卧的改良方式，既能保证患者的安全、减少不良反应，又能满足其生理需求，提高舒适度。     

Sonographically Guided Lumbar Puncture in Pediatric Patients

Our aim with this study was to develop a user‐friendly method for pediatric sonographically guided lumbar punctures so that we can visualize intrathecal anatomy, confirm intrathecal injection at the time of injection, and, most importantly, avoid ionizing radiation to a child's already radiosensitive pelvis. Sonographically guided lumbar puncture was prospectively performed in children aged 7 weeks to 16 years. All attempts (n = 9) were successful. We were able to identify relevant anatomy (including the conus in children 10 years and younger), confirm intrathecal injection, visualize intrathecal hematoma, and avoid radiation. Sonography is a promising modality for image‐guided lumbar punctures without radiation in children.     

不同体位对腰穿后头痛的影响

目的 评价不同体位对腰穿后头痛的影响,为临床选择最佳腰穿后体位提供依据。方法 用随机单盲法将符合条件的164例患者分成4组:A组(去枕平卧6h)、B组(平行位头抬高5cm平卧6h)、C组(头低脚高俯卧1h,左右交替侧卧或平卧5h)、D组(头低脚高俯卧1h,左右交替侧卧或平卧2h),观察其在腰穿术后6、24、48、72h头痛发生率、头痛程度、头痛持续时间及不适指标。结果 4组体位头痛发生率分别是23.80％、22.50％、27.50％、19.05％,头痛发生率、头痛程度、持续时间无显著差异(P>0.05);B组舒适率显著低于其他3组(P<0.05)。结论 D组体位为最佳腰穿后体位。     

Incidence of Traumatic Lumbar Puncture

OBJECTIVE: To determine the incidence of traumatic lumbar puncture (LP). METHODS: A retrospective study was conducted at an urban, university tertiary care referral center with 50000 annual emergency department (ED) visits. The study population included all patients who had cerebrospinal fluid (CSF) samples sent to the laboratory between August 15, 2000, and August 14, 2001. The numbers of red blood cells (RBCs) recorded in the first and last CSF tubes, the location where the LP was performed, and the discharge summary and the discharge diagnoses from the particular visit were obtained. All patients with intracranial pathology and CSF obtained via neurosurgical procedure or fluoroscopic guidance were excluded from the study group. Given no clear definition of traumatic LP in the literature, the incidence of traumatic LP was calculated using a cutoff of greater than 400 RBCs (visual threshold for bloody fluid) and 1000 RBCs (arbitrary threshold selected by other authors) in CSF tube 1. Proportions were compared using chi-square statistics. RESULTS: Seven hundred eighty-six CSF samples were recorded over one year. Twenty-four samples were obtained from patients with intracranial pathology or were obtained via a neurosurgical procedure. Of the remaining 762 CSF samples in the study population, 119 (15.6%) were traumatic using a cutoff of 400 RBCs, and 80 (10.5%) were traumatic, using a cutoff of 1000 RBCs in tube 1. Five hundred three LPs were done in the ED and 259 were attributed to all other locations in the hospital. Using a cutoff of 400 RBCs, the incidence of traumatic LP in the ED was 13.3%, compared with 20% in the rest of the hospital (p < 0.025). Similarly, using a cutoff of 1000 RBCs, the incidence of traumatic LP in the ED was 8.9%, compared with 13.5% in the rest of the hospital (p = 0.1). The incidence of "champagne taps" (defined as zero RBCs in the first and last tubes) in the ED was 34.4%, compared with 24.3% in the rest of the hospital (p < 0.01). CONCLUSIONS: The incidence of traumatic lumbar puncture is approximately 15% using a cutoff of 400 RBCs and 10% using a cutoff of 1000 RBCs. In this study, the rate of traumatic lumbar puncture was significantly less (with a cutoff of 400 RBCs) and the rate of champagne tap was significantly greater for LPs done in the ED compared with the rest of the hospital.     

Safety of Lumbar Puncture Performed on Dual Antiplatelet Therapy

Practice guidelines generally recommend delaying lumbar puncture (LP) in patients on dual antiplatelet therapy, with these recommendations often citing an increased risk of hemorrhagic complications, specifically the development of epidural hematomas. However, no data exist about the risks of performing an LP in the setting of dual antiplatelet therapy and conclusions are often based on data from spinal anesthesia literature. We reviewed the medical records of 100 patients who underwent LP while taking dual antiplatelet therapy. We recorded the number of traumatic and bloody cerebrospinal fluid results as well as the presence of any complications occurring within 3 months of the procedure. Complications requiring imaging or hospitalization were considered serious. The most common complication was back pain, which was reported by 2 patients, only 1 of which was ultimately found to be attributable to the procedure. No serious complications occurred. Cerebrospinal fluid analysis was consistent with a traumatic LP, defined as having at least 100 red blood cells per microliter, in 8% of cases. Bloody LP, defined as having 1000 red blood cells per microliter, occurred in 4% of cases. The percentage of traumatic or bloody LPs was within the range reported previously for LPs performed in any setting. Although this is a small study and additional review is necessary, performing LPs in the setting of dual antiplatelet therapy may not pose an increased risk of serious complications.     

痔疮患者术后快速康复护理循证实践

目的 探讨基于最佳证据的痔疮患者术后快速康复干预应用于临床实践并评价其效果。方法 采用JBI临床证据实践应用模式,检索快速康复中有关痔疮术后康复指导的相关证据,利用JBI证据推荐级别系统（2014版）进行证据质量评价,对审查指标运用FAME结构从可行性、适宜性、临床意义和有效性4个方面对审查指标进行评价。将采纳的证据转化为临床审查指标,通过查看护理记录、现场审查和问卷法的方式收集资料。比较证据应用前后痔疮术后患者治疗效果、肛门疼痛、并发症发生率。结果 证据应用后痔疮术后患者治疗效果高于证据应用前（P<0.05）;证据应用后痔疮术后患者在术后1 d和5 d肛门疼痛评分低于证据应用前（P<0.05）;证据应用后痔疮术后患者并发症发生率低于证据应用前（P<0.05）;11项指标中,指标11证据应用前已是100%,其余10项指标证据应用后执行率高于证据应用前,差异均有统计学意义（P<0.001）。结论 基于快速康复外科的循证护理实践可优化痔疮患者的术后管理,可提高患者治疗效果,减轻患者术后肛门疼痛,降低术后并发症的发生率,促进痔疮术后患者的快速康复。     

Ultrasound-assisted Lumbar Puncture in Pediatric Emergency Medicine

Background

Ultrasound-assisted lumbar puncture in the pediatric emergency medicine setting has not been well established, but ultrasound could serve as a valuable tool in this setting.

Objective

To assess whether ultrasound increases provider confidence in identifying an insertion point for lumbar puncture.

Methods

A feasibility study was conducted using a convenience sample of pediatric emergency patients requiring lumbar puncture. Provider confidence in selecting a needle insertion site for lumbar puncture using ultrasound assistance was compared to provider confidence using traditional landmarks alone. A simple technique using a linear probe is described.

Results

Nineteen patients were included in the study, with the primary end point the mean confidence score (based on a five-point Likert scale) in identifying a needle insertion site prior to and after using ultrasound. Using the Wilcoxon signed-rank test, the mean confidence score was 2.89 with the landmark procedure alone, and 4.79 with ultrasound assistance, yielding an average score difference of 1.90 (95% confidence interval 1.23–2.56; Wilcoxon p < 0.001, paired t-test p < 0.001). Thus, compared to the landmark procedure, the use of ultrasound was associated with a significantly higher average confidence score.

Conclusion

The use of ultrasound in the pediatric emergency setting can be a valuable adjunct with lumbar puncture.