Zhongguo cuzhong zazhi (May 2023)
蛛网膜下腔出血腰椎穿刺术后患者体位管理新模式的应用效果分析 Effect Analysis of a New Model of Posture Management after Lumbar Puncture in Subarachnoid Hemorrhage Patients
Abstract
目的 探讨体位管理新模式在蛛网膜下腔出血患者腰椎穿刺术后的应用效果。 方法 选取2021年2—12月在首都医科大学附属北京天坛医院神经外科住院治疗，并在局部麻醉下行腰椎穿刺术的蛛网膜下腔出血患者（改良Fisher分级0～Ⅱ级）作为研究对象。采用随机数字表法将患者分为试验组和对照组。试验组采用穿刺后体位管理新模式进行护理，对照组接受穿刺后常规护理。对两组干预后即刻（4 h）和短期（24 h）头部、腰背部疼痛发生率，疼痛严重程度，以及术后24 h患者满意度等指标进行比较。 结果 试验组和对照组腰椎穿刺术后4 h（41.2% vs. 37.5%，P=0.627）和术后24 h（25.0% vs. 22.5%，P=0.710）头痛发生率的差异均不具有统计学意义，头痛严重程度分级的差异亦均无统计学意义（P=0.533，P=0.685）；对照组术后4 h（50.0% vs. 27.5%，P=0.003）和24 h（37.5% vs. 22.5%，P=0.038）腰背痛的发生率均显著高于试验组，且两组术后4 h和24 h腰背痛的疼痛程度分级差异亦均有统计学意义（P=0.005，P=0.033）。术后24 h对照组护理满意度总分为（78.19±3.17）分，试验组为（88.41±2.80）分，试验组显著高于对照组（P=0.003），试验组在尊重患者、护理技术、身体舒适、健康教育、沟通交流以及患者和家属参与护理等指标方面优于对照组，差异均有统计学意义。 结论 体位管理新模式适用于有腰椎穿刺需求的蛛网膜下腔出血轻症患者，该模式通过缩短腰椎穿刺术后患者的卧床时间，在不增加术后头痛发生率的同时，显著降低患者术后短期内腰背部疼痛的发生率和严重程度，提升患者满意度，值得临床推广应用。 Abstract: Objective To explore the effect of the new model of posture management in subarachnoid hemorrhage patients after lumbar puncture (LP) . Methods Subarachnoid hemorrhage patients (modified Fisher classification 0-Ⅱgrades) who were hospitalized in the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from February to December 2021 and underwent lumbar puncture under local anesthesia were selected as the research objects. The patients were randomly divided into the intervention group and the control group by the random control table method. The control group used routine nursing, and the intervention group used the new model of posture management for nursing intervention. The immediate (4 h) and short-term (24 h) incidence of headache, low back pain, severity of pain, and satisfaction of patients 24 h after the intervention were compared between the two groups. Results There was no significant difference in the incidence of post lumbar puncture headache at 4 hours (41.2% vs. 37.5%, P=0.627) and 24 hours (25.0% vs. 22.5%, P=0.710) respectively, between the experimental group and the control group nor was there any significant difference in the severity of headache (P=0.533, P=0.685); the incidence of low back pain at 4 hours (50.0% vs. 27.5%, P=0.003) and 24 hours (37.5% vs. 22.5%, P=0.038) after LP in the control group was significantly higher than that in the intervention group, and there was statistical significance between the control group and the intervention group on the severity of low back pain 4 hours and 24 hours after LP (P=0.005, P=0.033). The total score of nursing satisfaction 24 hours after LP was 78.19 ± 3.17in the control group and 88.41 ± 2.80 in the intervention group, which was significantly higher than that in the control group (P=0.003). The two groups showed statistical differences in aspects of respect level, nursing techniques, comfort level, health education, communication, and patient family participation. Conclusions The new mode of posture management is applicable for patients with mild subarachnoid hemorrhage requiring lumbar puncture. By shortening the bedtime of patients after lumbar puncture, this mode can significantly reduce the incidence and severity of low back pain in a short period of time after surgery without increasing the incidence of postoperative headache, and improve patient satisfaction, which is worthy of clinical promotion and application.
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