学龄期急性白血病患儿首次腰椎穿刺后最佳平卧时间探讨  

Discussion on supine time of school-aged children with acute leukemia after first lumbar puncture

作　　者：汪清 韩勤 戴谦[1] Wang Qing;Han Qin;Dai Qian(Department of Hematology,Children's Hospital Affiliated to Nanjing Medical University,Nanjing 210000,China)

机构地区：[1]南京医科大学附属儿童医院血液肿瘤科,南京210000

出　　处：《中国实用护理杂志》2022年第24期1841-1846,共6页Chinese Journal of Practical Nursing

摘　　要：目的探讨学龄期急性白血病患儿首次腰椎穿刺后最佳平卧时间。方法选取2020年1月至2021年12月南京医科大学附属儿童医院血液肿瘤科收治的152例急性白血病患儿作为研究对象,按照随机数字表法分为4组,分别为腰椎穿刺后平卧时间1 h组、2 h组、3 h组和4 h组,各38例;观察4组患儿腰椎穿刺后不同平卧时间头痛、腰背痛、舒适度以及术后并发症情况。结果最终1 h组纳入38例,2 h组纳入36例,3 h组纳入38例,4 h组纳入34例。1 h组腰背痛、睡眠舒适度、卧位舒适度、情绪舒适度评分以及肢体麻木发生率分别为(1.71±0.56)、(1.95±0.87)、(2.74±1.06)、(2.63±0.79)分和5.3%(2/38),2 h组分别为(1.61±0.27)、(2.08±0.81)、(2.92±1.34)、(2.86±0.80)分和2.8%(1/36),明显低于3 h组和4 h组的(2.32±1.12)、(2.92±1.34)、(3.71±1.11)、(3.55±1.25)分、21.1%(8/38)和(2.74±1.42)、(3.06±1.37)、(3.85±1.50)、(3.88±0.81)分、23.5%(8/34),差异有统计学意义(F值为6.81~14.08,χ^(2)=10.84,均P<0.05)。1 h组脑脊液渗出量为(0.33±0.09)g,明显高于2 h组、3 h组和4 h组的(0.27±0.08)、(0.27±0.10)、(0.24±0.09)g,差异有统计学意义(F=5.82,P<0.05)。1 h组、2 h组、3 h组皮肤潮红/压痕发生率分别为0、2.8%(1/36)、7.9%(3/38),明显低于4 h组的23.5%(8/34),差异有统计学意义(χ^(2)=15.39,P<0.05)。4组患儿头痛评分差异无统计学意义(P>0.05)。结论急性白血病患儿首次腰椎穿刺后平卧时间2 h不增加脑脊液渗出量,且可以有效缓解腰背痛,改善舒适度。Objective To investigate the optimal lengths of supine position after first lumber puncture for school-aged children with acute leukemia.Methods From January 2020 to December 2021,a total of 152 children with acute leukemia who underwent first lumbar puncture were randomly divided into 1h group,2 h group,3 h group and 4 h group,there were 38 cases in each group.The lengths of supine position after lumber puncture were 1 h,2 h,3 h and 4 h in the 1h group,2 h group,3 h group and 4 h group,respectively.The effects of different lengths of supine position on headache,low back pain,comfort and postoperative complications were observed.Results Finally,38 cases were enrolled in the 1 h group,36 cases in the 2 h group,38cases in the 3 h group and 34 cases in the 4 h group.The scores of low back pain,sleep comfort,lying position comfort,emotional comfort as well as the incidence of limb numbness in the 1 h group were(1.71±0.56),(1.95±0.87),(2.74±1.06),(2.63±0.79),5.3%(2/38),in the 2 h group were(1.61±0.27),(2.08±0.81),(2.92±1.34),(2.86±0.80),2.8%(1/36),which were significant lower than those of in the 3 h group(2.32±1.12),(2.92±1.34),(3.71±1.11),(3.55±1.25),21.1%(8/38)and 4 h group(2.74±1.42),(3.06±1.37),(3.85±1.50),(3.88±0.81),23.5%(8/34),F=6.81 to 14.06,χ^(2)=10.84,all P<0.05.The amount of cerebrospinal fluid exudation in 1 h group was(0.33±0.09)g,which was significantly higher than that in 2 h group(0.27±0.08)g,3 h group(0.27±0.10)g and 4 h group(0.24±0.09)g,the difference was significant(F=5.82,P<0.05).The incidence of pressure injury in 1 h group,2 h group and 3 h group were 0,2.0%(1/36),7.9%(3/38),which were significantly lower than that in the 4 h group 23.5%(8/34),χ^(2)=15.39,P<0.05.There was no significant difference in pain scores among the 4 groups(P>0.05).Conclusion Two hours for supine position after first lumber puncture does not increase cerebrospinal fluid exudation in children with acute leukemia,and effectively alleviate low back pain,improve the comfort degree.

关 键 词：儿童 急性白血病 腰椎穿刺 平卧 舒适度 并发症 

分 类 号：R473.73[医药卫生—护理学]