I) signs
1. The diagnosis and differential diagnosis of inflammatory diseases in the central nervous system include purulent meningitis, tuberculous meningitis, viral meningitis, fungal meningitis and Japanese encephalitis.
2. The diagnosis and differential diagnosis of cerebrovascular accidents include cerebral hemorrhage, cerebral infarction and subarachnoid hemorrhage.
3. Diagnosis and treatment of tumor diseases are used to diagnose meningeal leukemia, and chemotherapy drugs are injected into the sheath through lumbar puncture to treat meningeal leukemia.
(2) Operation method
1. The patient lies on his side on a hard bed, with his back perpendicular to the bed surface, his head bent forward to his chest, his arms pressed against his abdomen, and his torso arched. Or is the assistant standing opposite the operator, holding the patient's head with one hand and both lower limbs with the other? Hold tightly at the fossa to make the spine protrude as far as possible, so as to increase the width of intervertebral space and facilitate needle insertion.
2. Take the intersection of the connecting line of the posterior superior iliac spine and the posterior midline as the puncture point, and generally take the spinous process space of the third to fourth lumbar vertebrae, or take the upper or lower intervertebral space.
3. Routine disinfection of skin, wearing sterile gloves, spreading disinfection hole towel, and local infiltration anesthesia from skin to intervertebral ligament with 2% lidocaine.
4. The surgeon fixes the skin of the puncture point with his left thumb and forefinger, and slowly pierces the puncture needle with his right hand in the direction perpendicular to the back. When the needle passes through the ligament and dura mater, he can feel the resistance suddenly disappear (the depth of needle penetration is 4-6 cm for adults and 2-4-6 cm for children). At this time, slowly pull out the needle core and see the colorless and transparent cerebrospinal fluid flowing out.
5. When the cerebrospinal fluid is about to flow out, connect a manometer to measure the pressure, accurately read it, or count the number of cerebrospinal fluid drops to estimate the pressure (normally 70 ~ 180 mmh).
2 O or 40 ~ 50 drops. Minimum). If the pressure is not high, the assistant can press one jugular vein 10s, then press the other jugular vein, and finally press both jugular veins at the same time. If the cerebrospinal fluid pressure is doubled rapidly, the release pressure 10 ~ 20s will drop to the original level rapidly, indicating that the subarachnoid space is unobstructed. If the pressure does not increase after pressing the vein, it means that the subarachnoid space is completely blocked. If the pressure increases slowly after pressing, it decreases slowly after relaxing.
6. Remove the manometer, collect 2 ~ 5ml of cerebrospinal fluid, and send it to routine, biochemical and bacterial culture.
7. To treat meningeal leukemia, we usually dilute 10 mg methotrexate (MTX) with 4ml normal saline and add 5mg dexamethasone. Injection is slowly injected into spinal canal, and the drug concentration is continuously diluted with cerebrospinal fluid, generally within 10min.
8. After the operation, insert the needle core, pull out the puncture needle together, cover it with sterile gauze and fix it with adhesive tape.
9. Lying on the back for 4 ~ 6 hours after operation can avoid postoperative headache with low intracranial pressure.
(3) Precautions
1. Strict aseptic operation to avoid microvascular damage during puncture.
2. If the patient has abnormal changes such as breathing, pulse and pallor during puncture, the operation should be stopped immediately.
3. When intrathecal administration, the same amount of cerebrospinal fluid should be released first, and then the same amount of drugs should be injected to avoid intracranial hypertension or hypotensive headache.
(4) Contraindications
1. Patients with increased intracranial pressure.
2. Patients in shock, failure or danger.
3. There is inflammation in the local skin (near the puncture point).
1.
Take cerebrospinal fluid to check its pressure, inject oxygen or iodine injection into spinal canal for brain and spinal cord angiography to help diagnosis, and inject drugs into spinal canal for treatment. Drainage of inflammatory secretions, bloody cerebrospinal fluid or contrast agent from spinal canal, and release of appropriate cerebrospinal fluid to improve clinical symptoms.
Step 2 instruct
Commonly used in cerebrovascular diseases, infectious diseases of central nervous system, brain surgery, craniocerebral trauma, spinal cord diseases, etc.
3. Contraindications
3. 1 Intracranial pressure is obviously increased, especially in patients with space-occupying lesions in the posterior cranial fossa, or patients with suspected early cerebral hernia, lumbar puncture is prohibited to prevent cerebral hernia and sudden death.
3.2 If there are infected lesions in the skin or subcutaneous tissue at the puncture site, lumbar puncture is prohibited to prevent bacteria from being brought into the central nervous system.
3.3 Sepsis and other systemic infectious diseases. For patients with extremely critical illness, restlessness or high cervical trauma or space-occupying lesions, it is not appropriate to forcibly perform lumbar puncture.
Use articles
Treatment tray: 2% iodine, 75% alcohol, sterile cotton ball, gauze, 1 ~ 2% procaine, sterile lumbar puncture kit, manometer and sterile gloves. Tape, matches, clean test tubes. Prepare culture tubes and alcohol lamps if necessary.
5. Patient preparation
5. 1 procaine allergy test should be carried out before puncture.
5.2 Puncture the front row to urinate.
5.3 During puncture, the patient lies on the side of the bed, hands clasped, knees bent to the chest, head bent forward and held in a spherical shape, spine should be parallel to the bed surface, pelvis should be vertical to the bed surface, so as to increase the lumbar intervertebral space during puncture.
6. Method
6. 1 Put the lumbar puncture disc end on the patient's bedside to help the patient set up.
6.2 There should be a special person to fix the patient's position during puncture, so as to avoid moving and prevent the needle from breaking.
6.3 Take the third, fourth or fourth, fifth lumbar intervertebral space for puncture. After successful puncture, cerebrospinal fluid will flow out. Assist the doctor to install piezometric tube, compress jugular vein or abdomen, observe the dynamics of cerebrospinal fluid, and record the pressure before and after cerebrospinal fluid outflow.
6.4 During puncture, observe the changes of patients' complexion, consciousness, pupil, pulse and breathing. Report the abnormality to the doctor immediately, stop the operation and assist in the rescue.
6.5 During the culture of cerebrospinal fluid bacteria, the aseptic test tube mouth should be flame sterilized on an alcohol lamp or directly connected with the outflow cerebrospinal fluid with a Petri dish, and then the test tube should be sterilized by the above method, covered with a sterile plug and sent for inspection immediately. If intracranial pressure is high, cerebrospinal fluid cannot flow out quickly. A manometer with an inner diameter of 1mm should be used to make cerebrospinal fluid flow out slowly to prevent cerebral hernia.
6.6 After lumbar puncture, the puncture point is covered with sterile gauze.
7. Preventive measures
7. 1 Strictly carry out aseptic operation and collect cerebrospinal fluid for immediate inspection.
7.2 cerebrospinal fluid release should not be too fast to prevent brain sores.
7.3 Skillfully cooperate, avoid rudeness, pull out the needle slowly, and avoid cerebrospinal fluid leakage.
8. Nursing
8. 1 explain the significance and precautions of puncture to patients before puncture, so as to facilitate cooperation.
8.2 Give the patient procaine test before puncture, and prepare the lumbar puncture disc.
8.3 assist patients to set their own position.
8.4 Let the patient lie flat for 4 ~ 6 hours after puncture.
8.5 Patients with postoperative headache and elevated body temperature should be closely observed for meningitis.
8.6 When postoperative patients have nausea, vomiting, dizziness and headache, they can lie down and rest, and give sedatives and painkillers according to the doctor's advice when necessary.