不同颅内压病人腰麻术后体位变化对头痛及舒适度的影响  

Influence of posture changes on postdural puncture headache and comfort of patients with different intracranial pressure after spinal anesthesia

作　　者：梁瑞晨 张代英 丁玉辉 曾梁楠 李倩茜 明霞 唐容 骆雪英 杨昌美 LIANG Ruichen;ZHANG Daiying;DING Yuhui;ZENG Liangnan;LI Qianqian;MING Xia;TANG Rong;LUO Xueying;YANG Changmei(The Affiliated Hospital of Southwest Medical University,Sichuan 646000 China)

机构地区：[1]西南医科大学附属医院,四川646000 [2]西南医科大学护理学院

出　　处：《循证护理》2021年第7期878-884,共7页Chinese Evidence-Based Nursing

基　　金：四川省卫生和计划生育委员会科研项目,编号:16PJ579。

摘　　要：目的:探究不同颅内压病人腰麻术后体位变化对头痛及舒适度的影响。方法:选取泌尿外科腰麻微创手术病人180例作为研究对象,按照纳入及排除标准,选取临界低颅压水平段、正常颅压水平段、临界高颅压水平段病人各60例,将每个水平段的颅内压病人分别随机采用不同体位进行干预,传统组采取去枕平卧位(各20例),对照组采用垫枕平卧位(各20例),试验组采取垫枕平卧与侧卧结合体位(各20例),观察不同颅内压病人腰麻术后3种体位的头痛发生及舒适度情况。结果:临界低颅压水平段病人头痛发生率高于正常颅压水平段和临界高颅压水平段(P<0.05);在不同颅内压状态下,试验组舒适度评分均高于对照组(P<0.001),对照组舒适度评分均高于传统组(P<0.001);传统组颈肩痛、腰背痛发生率均高于对照组(P<0.05),对照组颈肩痛、腰背痛发生率均高于试验组(P<0.05)。结论:当病人颅内压处于临界低颅压水平段状态时,腰麻术后头痛与体位变化无关,与颅内压力高低有关,这可能与机体的自身调节有一定的关联。临界低颅压的病人腰麻术后更容易发生头痛;当病人颅内压处于正常颅压水平段或临界高颅压水平段状态时,腰麻术后体位变化对头痛无明显影响;垫枕平卧与侧卧结合位比去枕平卧位、垫枕平卧位在改善不同颅内压病人腰麻术后舒适度方面具有优势。垫枕平卧与侧卧结合位能显著降低病人术后颈肩痛、腰背痛的发生率,提高就医体验。Objective:To explore the influence of posture changes on headache and comfort of patients with different intracranial pressure after spinal anesthesia.Methods:According to the inclusion and exclusion criteria,180 patients with minimally invasive surgery under spinal anesthesia in urology department,were selected as the research objects.Totally,60 patients with critical low intracranial pressure,60 patients with normal intracranial pressure and 60 patients with critical high intracranial pressure were selected.Patients with intracranial pressure at each level,were randomly intervened with different positions.The traditional group was given pillow free supine position(20 cases in each group),the control group was given pillow supine position(20 cases in each group),and the experimental group was given pillow supine position combined with lateral position(20 cases in each group).Postdural puncture headache and comfort were observed among patients with different intracranial pressure,who took three different postures after spinal anesthesia.Results:The incidence of headache in patients with critical low intracranial pressure was higher than tha t in patients with normal intracranial pressure and critical high intracranial pressure(P<0.05).Under different intracranial pressure conditions,the comfort score of the experimental group was higher than that of the control group(P<0.001),and the comfort score of the control group was higher than that of the traditional group(P<0.001).The incidences of neck shoulder pain and low back pain in the traditional group were higher than that in the control group(P<0.05).While,the incidences of neck shoulder pain and low back pain in the control group were higher than that in the experimental group(P<0.05).Conclusion:When the patient′s intracranial pressure was in the state of critical low intracranial pressure,the headache after spinal anesthesia had nothing to do with the change of posture.It had something to do with the level of intracranial pressure,which might be related to th

关 键 词：腰麻 头痛 颅内压 体位 舒适度 护理 

分 类 号：R473.6[医药卫生—护理学]