脑脊液漏的护理

1、The 3rd Affiliated Hospital Of Southern Med. Univ.The 3rd Affiliated Hospital Of Southern Med. Univ. The 3rd Affiliated Hospital Of Southern Med. Univ.2The 3rd Affiliated Hospital Of Southern Med. Univ. 无色透明的液体，充满在无色透明的液体，充满在各脑室、蛛网膜下腔和各脑室、蛛网膜下腔和脊髓中央脊髓中央管管内。由脑室中的脉络丛产生内。由脑室中的脉络丛产生与血浆和淋巴液的性质与血浆和淋巴液的性质相

2、似，略带粘性。相似，略带粘性。3The 3rd Affiliated Hospital Of Southern Med. Univ.4The 3rd Affiliated Hospital Of Southern Med. Univ.a.a. 缓冲外力对缓冲外力对脑、脊髓、神经脑、脊髓、神经根根的影响的影响b.b. 调节调节颅内压力颅内压力和平衡脑血流和平衡脑血流量量c.c. 充当清除脑细胞充当清除脑细胞代谢产物代谢产物与与毒素毒素d.d. 营养脑神经营养脑神经5The 3rd Affiliated Hospital Of Southern Med. Univ.6The 3rd Affilia

3、ted Hospital Of Southern Med. Univ. 脑脊液脑脊液腔腔与颅外与颅外相通相通；有脑；有脑脊液脊液漏出漏出者称为脑脊液漏。者称为脑脊液漏。（cerebrospinal fluidleakage,CSFL）7The 3rd Affiliated Hospital Of Southern Med. Univ.8The 3rd Affiliated Hospital Of Southern Med. Univ. 脑脊液漏是脊柱手术常见并发症之一脑脊液漏是脊柱手术常见并发症之一 脑脊液漏的发生率约为脑脊液漏的发生率约为2.31%9.37%9The 3rd Affiliat

4、ed Hospital Of Southern Med. Univ.10The 3rd Affiliated Hospital Of Southern Med. Univ.a.脊柱爆裂性骨折碎脊柱爆裂性骨折碎骨块刺破硬脊膜骨块刺破硬脊膜b.脱位时撕破硬脊膜脱位时撕破硬脊膜a.咳嗽、喷嚏咳嗽、喷嚏b.便秘便秘c.过早坐起或站立过早坐起或站立（腹压骤然升高腹压骤然升高, 硬膜囊内压力瞬间增大）硬膜囊内压力瞬间增大）11The 3rd Affiliated Hospital Of Southern Med. Univ.a.脊髓脊髓疾病需要疾病需要切开硬脊膜切开硬脊膜b.松解粘连时撕裂松解粘连时撕裂c

5、.肿瘤手术时肿瘤手术时肿瘤组织与硬脊膜粘连肿瘤组织与硬脊膜粘连 d.经验不足操作不熟练经验不足操作不熟练 e.术中视野不清、操作不当误伤术中视野不清、操作不当误伤 12The 3rd Affiliated Hospital Of Southern Med. Univ.13The 3rd Affiliated Hospital Of Southern Med. Univ.a.引流引流大量大量的的淡红色淡红色血性液体或血性液体或清亮清亮液体液体b.伤口有伤口有淡红色淡红色血性液或血性液或清亮清亮液体渗出液体渗出c.术后术后头痛头痛、头晕头晕、呕吐呕吐且与且与姿势有关姿势有关14The 3rd Af

6、filiated Hospital Of Southern Med. Univ.15The 3rd Affiliated Hospital Of Southern Med. Univ.16a.感染：感染：椎管内感染椎管内感染、颅内感染颅内感染b.低颅内压症：低颅内压症：体位性头痛、头晕、呕吐体位性头痛、头晕、呕吐c.脑脊液囊肿：脑脊液囊肿：脑脊液压迫硬脊膜形成假性囊肿脑脊液压迫硬脊膜形成假性囊肿d.神经症状：神经症状：脑脊液压迫局部的神经，出现相应的神经症状脑脊液压迫局部的神经，出现相应的神经症状 The 3rd Affiliated Hospital Of Southern Med. Uni

7、v.17The 3rd Affiliated Hospital Of Southern Med. Univ.18a.a. 及时观察切口敷料有无及时观察切口敷料有无渗湿渗湿b.b. 一旦湿润必须一旦湿润必须及时及时通知医生通知医生换药换药c.c. 保持保持局部干燥、清洁局部干燥、清洁d.d. 保持患者床单位干净、整洁保持患者床单位干净、整洁e.e. 拔除引流后切口处用拔除引流后切口处用沙袋沙袋或或盐袋加迫盐袋加迫f.f. 观察局部是否形成观察局部是否形成脑脊液囊肿、脑脊液囊肿、切口愈合切口愈合后仍需观测后仍需观测1212周周g.g. 严密监测患者生命体征严密监测患者生命体征The 3rd Aff

8、iliated Hospital Of Southern Med. Univ.19a.a. 保持引流管的固定、通畅、有效保持引流管的固定、通畅、有效b.b. 观察观察引流液引流液的的颜色颜色、性质性质、量量c.c. 夹闭管道时，观察手术切口夹闭管道时，观察手术切口有无有无CSFCSF漏出漏出a.a. 严密监测患者生命体征严密监测患者生命体征The 3rd Affiliated Hospital Of Southern Med. Univ.20a.a. 颈椎术后患者尽量采用颈椎术后患者尽量采用端坐位端坐位b.b. 胸腰椎手术患者采用胸腰椎手术患者采用去枕平卧去枕平卧、头低脚高头低脚高位位或或俯卧

9、位俯卧位c.c. 行轴线翻身、避免脊柱扭曲行轴线翻身、避免脊柱扭曲d.d. 脑脊液漏停止后，继续保持治疗体位脑脊液漏停止后，继续保持治疗体位48 48 h h后恢复正常体位后恢复正常体位e.e. 严密监测患者生命体征严密监测患者生命体征The 3rd Affiliated Hospital Of Southern Med. Univ.21a.a. 应用可透过血脑屏障的应用可透过血脑屏障的抗菌素抗菌素b.b. 充分充分补充水、电解质补充水、电解质，防治电解质紊乱、，防治电解质紊乱、颅内压过低颅内压过低c.c. 适当补充适当补充白蛋白白蛋白或少量或少量血浆血浆d.d. 配合全身支持、营养治疗配合全

10、身支持、营养治疗e.e. 给予润肠药物、避免给予润肠药物、避免大便秘结大便秘结增高负压增高负压f.f. 严密监测患者生命体征严密监测患者生命体征The 3rd Affiliated Hospital Of Southern Med. Univ.22a.a. 愈合前愈合前禁止禁止患者下床活动患者下床活动b.b. 避免咳嗽避免咳嗽及及用力屏气用力屏气等加大腹压活动等加大腹压活动c.c. 向患者解释病情，鼓励患者积极配合治疗。向患者解释病情，鼓励患者积极配合治疗。d.d. 指导患者需指导患者需保持大便通畅保持大便通畅e.e. 指导患者指导患者高蛋白高蛋白、高纤维高纤维饮食、饮食、忌辛辣忌辛辣f.f. 询问患者有无头晕、