成年人诊断性腰椎穿刺后卧床时间和体位的最佳证据应用  

Best practice implementation of bedtime and position after diagnostic adult lumbar puncture

作　　者：陈金花[1] 马雅英 单燕敏[2] 朱莉莉 俞小蔚[1] 汤巧敏[1] 包营晓[1] 孔雪 Chen Jinhua;Ma Yaying;Shan Yanmin;Zhu Lili;Yu Xiaowei;Tang Qiaomin;Bao Yingxiao;Kong Xue(Neurology Department of the Second Affiliated Hospital of Zhe jiang University School of Medicine,Hangzhou,310009,China;Diabetes Department of the Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou,310009,China;Operating theater of The Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou,310009,China)

机构地区：[1]浙江大学医学院附属第二医院神经内科,杭州310009 [2]浙江大学医学院附属第二医院糖尿病专科,杭州310009 [3]浙江大学医学院附属第二医院手术室,杭州310009

出　　处：《中国实用护理杂志》2020年第4期263-267,共5页Chinese Journal of Practical Nursing

摘　　要：目的通过成年人诊断性腰椎穿刺后卧床时间和体位的最佳证据应用,以期建立科学规范的腰椎穿刺术护理常规,缩短术后卧床时间,提高患者的舒适度。方法通过对成年人腰椎穿刺后体位、卧床时间、低颅压头痛等相关主题进行系统检索及质量评价,总结生成6条最佳证据,通过与临床情景结合,制订审查指标,在浙江大学医学院附属第二医院神经内科病房开展证据的应用。结果经2轮审查,除患者对新证据的依从性为93.3%外,其余4条指标达标率均为100%。证据应用前后比较,腰椎穿刺后患者低颅压头痛以及头晕发生率差异无统计学意义(P>0.05),腰背痛发生率由28.3%(30/106)降至15.1%(18/119),差异有统计学意义(χ2值为5.799,P=0.016)。结论该最佳证据的应用,表明腰椎穿刺后患者不必常规去枕平卧4~6 h,垫枕休息或起床活动的患者腰背痛发生率减低,舒适度提高。Objective By implementing the best practice of bedtime and position after diagnostic adult lumbar puncture,we hope to establish a scientific and standardized nursing routine for lumbar puncture,shorten the bed-rest time after lumbar puncture,and improve the comfort of patients.Methods By reviewing literatures related to positions after adult lumbar puncture and post-dural puncture headache,six best practice were concluded.By combining the best evidence and the clinical circumstances,the evidenced-based criteria were established and then applied in the Neurology Department.Results After two rounds of reviews,the results showed that except the 93.3%compliance with the new evidence,all other four criteria had 100%complacence.Comparing before and after applying the evidence,there was no statistically significant difference for the occurrence of post-dural puncture headache or dizziness(P>0.05),there was a statistically significant reduction of back pain from 28.3%(30/106)to 15.1%(18/119)(χ2 value was 5.799,P<0.05)when the evidence was applied.Conclusions The best practice shows that patients needn′t lie on bed for 4 to 6 hours after lumbar puncture,the occurrence of back pain is lowered and the comfort level of the patient is improved in those who rest with pillow or activities.

关 键 词：腰椎穿刺术 时间 卧床 体位 最佳实践 

分 类 号：R473[医药卫生—护理学]