Sut i ofalu ar ôl twll meingefnol

Mae tyllu meingefnol yn dechneg diagnosis a thriniaeth bwysig iawn a ddefnyddir yn gyffredin mewn amrywiol adrannau clinigol. Gyda chynnydd parhaus gwyddoniaeth feddygol, mae tyllu meingefnol hefyd yn cael ei ddefnyddio'n eang mewn pediatreg, ac mae cydweithrediad ac ymyrraeth nyrsio effeithiol yn chwarae rhan bwysig yn natblygiad llyfn yr arholiad, gan wella cyfradd llwyddiant twll a lleddfu poen plant.

1 Gofal cyffredinol

1.1 Osgo a safle'r corff

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 Gofal ar ôl llawdriniaeth

1.2.1 Safle supine

Gorweddwch i lawr gyda'r gobennydd wedi'i dynnu am 4 i 6 awr, yn dibynnu ar gyflwr y plentyn. I'r rhai sy'n gyfarwydd â defnyddio gobenyddion, rhowch gobennydd tenau (3 cm i 5 cm o drwch) y tu ôl i'r pen i ymlacio cyhyrau'r gwddf. Hefyd rhowch gobennydd tenau i atal anghysur cefn ar ôl twll.

1.2.2 Arsylwi ar glefydau

Monitro tymheredd y corff yn ddeinamig, pwls, resbiradaeth, pwysedd gwaed, ymwybyddiaeth, disgyblion, chwydu, cur pen, ac ati, a rhoi gwybod am unrhyw annormaleddau i'r meddyg mewn pryd.

1.2.3 Gofal seicolegol

Dylid gwneud gofal seicolegol cyn y twll, a dyma'r allwedd i ddileu pryderon rhieni. Oherwydd dylanwad cysyniadau traddodiadol, mae gan rieni wrthwynebiad penodol i dyllu meingefnol, ac maent yn ofni na fydd y plentyn yn smart ar ôl twll meingefnol neu'n gadael y sequelae o dyllu meingefnol. Felly, dylai rhieni wneud gwaith esbonio manwl i newid eu dealltwriaeth a dileu eu pryderon. , Dylanwadu ar y plentyn i gydweithredu â'r driniaeth gydag agwedd ac iaith gadarnhaol, ac osgoi rhoi awgrymiadau drwg i'r plentyn a chynyddu ei ofn.

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 Gofal symptomatig

2.1 Ymyrraeth nyrsio ar gyfer cur pen ar ôl twll meingefnol

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, based on the principle of prevention, strictly disinfect the puncture equipment and the patient's skin, and do not mix the local anesthetic liquid into the air or blood. 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 Gofal nyrsio am boen cefn isel ar ôl twll meingefnol

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 diseases, and the diagnosis and treatment of diseases should not be delayed because of worries, and explain to them the generation process of cerebrospinal fluid, and 500 mL of cerebrospinal fluid is generated every day. , 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.

2.3 Gofal nyrsio am ddraeniad parhaus tyllau meingefnol

2.3.1 Paratoi cyn llawdriniaeth

Paratowch drocar epidwral 18-mesurydd 18, cathetr epidwral, bag draenio di-haint wedi'i wneud eich hun gyda falf rheoleiddio cyflymder (gall codi hylif cyffredin a bag draenio di-haint hefyd fod yn defnyddio yn lle), a thiwb ti os oes angen monitro pwysau mewngreuanol ,Monitro.

2.3.2 Cydweithrediad rhynglawdriniaethol

Os oes gan y claf symptomau amlwg o bwysau mewngreuanol cynyddol, megis cur pen difrifol, chwydu aml, ac ati, gellir perfformio trwythiad mewnwythiennol cyflym o 20 y cant o manitol hanner awr cyn y twll. Ar gyfer plant aflonydd, gall tawelyddion mewngyhyrol fel sodiwm luminal gael eu chwistrellu hanner awr cyn llawdriniaeth. Cynorthwyo'r plentyn i gynnal y safle corff cywir, fel arfer dewiswch y bwlch rhwng gwasg 3 a gwasg 4 neu rhwng gwasg 4 a gwasg 5, a diheintiwch groen yr ardal twll yn llym. Ar ôl tyllu llwyddiannus, gosodwyd cathetr epidwral ar hyd y caniwla epidwral i'r gofod isaracnoid cephalic, a chysylltwyd bag draenio di-haint caeedig gyda falf rheoleiddio cyflymder ar y diwedd. Clymwyd y cathetr epidwral i'r cefn gyda thâp di-haint a gosodwyd pêl gotwm di-haint i lygad y nodwydd.

2.3.3 Gofal ar ôl llawdriniaeth a rhagofalon

Adjust the dripping speed according to different needs, preferably no more than 20 drops per minute, too fast and excessive drainage may cause the risk of intracranial hematoma or brain herniation. The amount of cerebrospinal fluid drainage should be controlled according to the needs. The total amount of intraoperative drainage is 40 mL to 60 mL, and the daily drainage amount for preventive and therapeutic treatment is about 150 mL and 350 mL, respectively. For those who need blood cerebrospinal fluid replacement, normal saline can be injected through the three-way tube. The volume of normal saline should be less than the amount of cerebrospinal fluid released each time. Intrathecal antibiotics can also be injected through the three-way tube to treat intraventricular infection. Avoid twisting and breaking the catheter to prevent the drainage tube from being blocked. Because the catheter is thin and easy to be blocked by the broken tissue in the cerebrospinal fluid, it can be flushed with a small amount of normal saline. Pay attention to aseptic operation. Redness at the puncture needle eye can be disinfected with iodophor or ethanol cotton balls, and then replaced with sterile dry cotton balls. And daily monitoring of cerebrospinal fluid routine. Pay attention to the patient's position, and you can change the position between 15 degree and 30 degree of head height to avoid pressure ulcers.

Os oes gennych unrhyw gwestiynau, cysylltwch â ni. Gall ein cwmni gynhyrchu gwahanol nodwyddau wedi'u haddasu, nodwyddau meddygol, nodwyddau tyllu, nodwyddau hypodermig, nodwyddau biopsi, nodwyddau brechlyn, nodwyddau pigiad, nodwyddau chwistrell, nodwyddau milfeddygol, nodwydd pwynt pensil, nodwyddau codi ofwm, nodwyddau asgwrn cefn, ac ati. cynhyrchion nodwydd, cysylltwch â ni. Edrychwn ymlaen at eich ymholiad! Bydd ansawdd y cynhyrchion a gynhyrchir yn ein ffatri yn sicr o fodloni chi!

Cysylltwch â ni os oes angen: zhang@sz-manners.com