腰椎术后合并脑脊液漏的治疗与护理.docx

位，避免增加腹压，预防感染，进行心理护理。结果 腰椎术后合并发脑脊液漏在临床上比较常见，严密观察病情，及时治疗与精心护理，患者均可治愈。结论 脑脊液漏是腰椎术后的并发症，如果处理不当，会发生严重后果的危险，应采取有效的治疗措施及针对性的护理，提高专科护理质量。脑脊液漏是腰椎手术后的较常见的并发症之一，治疗与护理都非常重要，如果治疗与护理不当，会发生严重后果的危险。本院2008年9月2014年9月，我科进行了腰椎手术465例，术后出现脑脊液漏25例，由于治疗及时并进行严密病情观察与精心护理，无1例发生感染和脑脊髓膜炎等严重并发症。现将治疗与护理汇报如下：1资料与方法1.1一般资料 25例脑脊液漏并发症患者中，男性18例，女性7例，平均年龄45岁，腰椎爆裂性骨折行减压、复位、内固定手术10例，腰椎间盘突出症合并腰椎管狭窄手术11例，单纯腰椎间盘突出症手术4例。1.2方法 脊柱术后一旦出现脑脊液漏，更换切口敷料和预防使用抗生素，延长术区引流时间和经皮蛛网膜下腔引流1。采用头低脚高位，避免增加腹压，预防感染，加强病情观察等。25例患者经过保守治疗而愈合，无1例发生切口感染、椎管内感染、脑脊髓膜炎等并发症。2护理2.1病情观察 患者术毕返回病房时，应向麻醉师或术者了解患者术中情况，术后用心电监护仪监测生命体征直至平稳，注意患者有无头痛、头昏、腰痛、颈项强直等症状，严密观察切口敷料渗血、渗液情况，并做好记录。2.2做好基础护理 患者术毕返回病房时，医务人员将患者安置正确的体位，防止脊柱扭曲，正确固定好伤口引流管，引流袋不要高于腰部切口，详细交接术中的情况，查看手术记录，有针对性的进行观察和护理。控制诱发因素，患者术后需要绝对卧床休息，所以术前必须练习床上解大小便，以适应术后卧床排便的需要，嘱患者进高蛋白、高热量、多维生素、易消化饮食，增强体抗力，保持大便通畅，勿用力排便。患者术后长期卧床，保持床单元清洁、干燥、无碎屑，床上擦浴2次/d，保持皮肤清洁，病房通风换气，保持空气新鲜，同时注意保暖，防止受凉引起咳嗽、打喷嚏。术后患者禁止做腰背肌、腹肌锻炼，勿让患者坐起或站立，以免发生脑脊液漏出现或加重。2.3切口和引流液的观察和护理 保持引流管固定、通畅，术后24h引流液持续增多，且引流液为清亮或淡红色，或切口纱布被浅红色或无色液体浸透者，或引流液出现分层，应确诊为脑脊液漏。正常引流液为暗红色血性液，一般引流液的量24h不超过300ml。2.4体位护理 体位是治疗脑脊液漏的重要方法，一旦确诊为脑脊液漏出，及时改变原来的平卧位为去枕平卧位或俯卧位，采取头低足高位，抬高床尾1030，直至脑脊液漏愈合，在愈合前禁止患者下床活动2，采取头低脚高位，抬高床尾可减低脊髓腔内脑脊液压力，增加颅腔脑脊液压力，而俯卧位较仰卧位更能促进引流量的减少及伤口闭合。其原因可能是俯卧位时，脑脊液由于重力作用而位于椎管腹侧，利于降低背侧漏口处脑脊液的压力，减少脑脊液外溢，同时由于俯卧位时脊髓漂浮于脑脊液之上而位于椎管背侧，可起到封堵漏口的作用3。2.5心理护理 出现脑脊液漏后，患者精神高度紧张，不利于身体康复，医务人员要用通俗易懂的语言解释相关知识，向患者解释外漏脑脊液类似于血浆，身体每天可以产生脑脊液，对今后的劳动及生活无影响，经过医生及时治疗与精心护理，可治愈，列举同病室或同病区其他类似且康复病例，使患者积极配合治疗与护理。2.6避免增加腹压 保持大便通畅，多食水果.蔬菜等粗纤维食物，勿食甜食以免引起腹胀，如果出现便秘，嘱咐患者勿用力大便，以免增加腹压，遵医嘱予缓泻剂，患者勿着凉，避免用力咳嗽或大声说笑，禁止坐起，禁止腰背肌功能锻炼。2.7预防感染 保持切口敷料清洁干燥，发现敷料潮湿及时更换敷料，并严格执行无菌操作，同时观察局部有无隆起及波动感。遵医嘱使用抗生素，保持床单位清洁干燥，观察生命体征，特别是体温的变化，如果患者发热，警惕有无感染。3结论腰椎手术合并脑脊液漏患者，要引起高度重视，发现异常及时采取有效治疗措施，严密观察病情与精心护理尤为重要，治疗与护理得当，有利于患者早日康复，治疗与护理不当，可导致严重并发症，甚至危及生命。And avoid increasing abdominal pressure, prevent infection, psychological nursing care. Results postoperative lumbar cerebrospinal fluid leakage in the more common clinical, strict observation condition, timely treatment and careful nursing, all patients can be cured. Conclusion cerebrospinal fluid leakage is lumbar spinal postoperative complications, if not handled properly, will be the risk of serious consequences, effective treatment measures should be taken and corresponding nursing, improve the quality of nurse.Cerebrospinal fluid leakage is one of the more common complications after lumbar spine surgery, treatment and nursing is very important, if improper treatment and nursing, will be at risk of serious consequences. In our hospital in September 2008 to September 2014, our department has carried on the lumbar spine surgery in 465 cases, 25 cases of postoperative cerebrospinal fluid leakage, because the treatment in a timely manner and carry on careful observation and elaborate care, no one case of serious complications such as infections and cerebrospinal meningitis. Now will report treatment and nursing is as follows:1 data and methods1.1 general information leakage of cerebrospinal fluid in patients with complications, 18 were male, female 7 cases, with an average age of 45, lumbar spine burst fracture line 10 cases, decompression, reduction and internal fixation surgery combined lumbar disc prolapse lumbar stenosis surgery in 11 cases, simple surgery, 4 cases of lumbar disc prolapse.1.2 method once the spinal postoperative cerebrospinal fluid leakage, replacement of incisional dressing and preventive use of antibiotics, YanChangShu zone time and percutaneous drainage subarachnoid drainage 1. Head down, adopt the high, avoid increase abdominal pressure, prevent infection, strengthen the observation and so on. 25 patients after conservative treatment and healing, 1 case of incision infection, spinal canal complications such as infection, cerebrospinal meningitis.2 care2.1 observe patients condition put ward, returning to the anesthesiologist or performer understand patients who, after the heart electricity guardianship meter monitoring vital signs until smooth, pay attention to the patients with and without headache, dizziness, back pain, neck stiffness and other symptoms, strict observation of incision dressing bleeding, drainage condition, and make records.2.2 never put off till tomorrow what you can do a good job in basic nursing (1) patients who return to room, medical staff put patients with correct position, preventing spinal twist, properly fixed wound drainage tube, drainage bag dont above the waist cut, handover in details, and check the operation record, targeted observation and nursing care. (2) to control the inducing factors, patients with postoperative need absolute bed rest, so preoperative must practice bed over urine, to meet the need of postoperative bowel movements in bed, instruct patients into high protein, high quantity of heat, vitamin, easy to digest food, strengthen the body resistance, maintain defecate unobstructed, do not forcibly defecate. (3) after surgery in bed for a long time, keep the sheets clean, dry, no debris, bed bath 2 times/d, maintain skin cleanness, ward ventilated take a breath, keep the air fresh, at the same time pay attention to keep warm, prevent catch cold catch cold cause cough, sneeze. Postoperative patients not to do back muscle and abdominal muscle exercise, do not let the patient sit up or stand, lest produce cerebrospinal fluid leakage or worsen.2.3 incision and drainage of fluid observation and nursing to keep the tube fixed, unobstructed, 24 h after drainage of liquid continues to increase, and drainage for liquid crystal or reddish, or incision gauze soaked in light red or colorless liquid, or a layered drainage fluid, should be diagnosed with cerebrospinal fluid leakage. Normal drainage for dark red liquid hemorrhagic fluid, general amount of 24 h, drainage of liquid less than 300 ml.2.4 body position nursing position is one of the important methods in the treatment of cerebrospinal fluid leakage, once the diagnosis of cerebrospinal fluid leakage, in a timely manner to change the original hypothesis for pillow hypothesis or prone position, head down, take the foot high, push up the end of the bed 10 30 , and cerebrospinal fluid leakage healing, ban bed patients before healing 2, head down, take the highs, pushing up the end of the bed can reduce cerebrospinal fluid pressure on the spinal column and increase the cranial cavity of cerebrospinal fluid pressure, and prone position is supine position more can promote the advantages of reducing and wound closure. The reason may be that the prone position, cerebrospinal fluid is located in the ventral spinal canal by gravity, to reduce the back sliding sideways mouth cerebrospinal fluid pressure, reduce cerebrospinal fluid spillover, at the same time due to spinal cord floating when prone position on the cerebrospinal fluid is located in the back and sides of the spinal canal, can have the effect of leak sealing mouth 3.2.5 psychological nursing, cerebrospinal fluid leakage after patients mental highly nervous, is not conducive to physical rehabilitation, medical personnel should use plain language to explain relevant knowledge, to explain to patients with leakage of cerebrospinal fluid is similar to plasma, body a day can produce cerebrospinal fluid, no influence to the future work and life, after the doctor timely treatment and careful nursing, treatable, list with ward or with other similar cases and rehabilitation, ward, actively cooperate with treatment and nursing.2.6 avoid increasing abdominal pressure Maintain defecate unobstructed, eat more fruit. Crude fiber food, such as vegetables, and dont eat sweets lest cause abdominal distension, if constipation, instruct patients do not forcibly defecate, lest increase abdominal pressure, prescribed in sugar-refining, patients dont catch a cold, avoid coughing or laughing loudly, si