改良小儿腰椎穿刺术300例临床分析

Clinical analysis on 300 cases of children by improvment lumbar puncture

目的观察应用改良小儿腰椎穿刺术行腰椎穿刺的临床效果。方法对传统小儿腰椎穿刺方法进行改进:(1)以一次性无菌注射针为穿刺针;(2)镇静:<7岁及≥7岁评估难以配合者,使用安定镇静;(3)不做麻醉。将600例患儿随机分为传统方法组和改良方法组各300例,观察和比较传统方法组和改良方法组的临床效果、穿刺成功率、术后并发症发生率及患儿配合情况。结果传统方法组总成功率79%(一次性成功率61.3%);改良方法组总成功率90.3%(一次性成功率83.7%),2组比较差异有统计学意义(P<0.05)。并发症发生率:传统方法组中头痛为6.5%,副损伤为14%,腰背痛为13.6%;改良方法组中头痛为2%,副损伤为5.7%,腰背痛为5.8%,2组各项比较差异均有统计学意义(P<0.05)。结论改良小儿腰椎穿刺术明显提高腰椎穿刺成功率,并发症发生率低,减少患儿痛苦及紧张,配合程度高,操作易行,值得临床推广。

Objective To obsewe the chinical effect of children by improved lumbar puncture. Methods The improvement of children lumbar puncture to the traditional method： （1）using single-use disposable hypodermic needle for paraeente-sis; （2）sedation： 〈7 years old ≥7 years old appraisal with difficulty coupler, using stable sedation; （3）no anesthesia. 600 children who had lumber puncture were dividedd into tradtional methods（n=300）and improved methods group （n=300）randomly. Between the two groups, puncture success rate, the incidence of postoperative complications and children cope with the situation-nation were observed and compared. Results Success rate of the tradtional methods group was 79 % （one-time success tate was 61.3 %）,improved methods group was 90. 3 % （one-time success rate was 83.7 %）, the diffrence between the two groups was statistically significant （P〈0. 05） ;The incidence of complications ： In tradtional methods heahache group was 6.5%, injure was 14%, backache was 13.6%; In improved methods group headache was 2%,injure was 5.7%, backache was 5.8%,the diffrence between the two groups was statistically significant（P〈0. 05）. Compatible with the total rate of tradtional methods group was 79 % （full compatible with the rate was 35 %） ;the improved methods group was 95.7% （full compatible with the rate was 88%） ,diffrence between the two groups was statistically significant （P〈0. 05）. Conclusion Improved lumber puncture in children markedly increased lumber success rate, the complication formation rate was low; It can reduce the child pain and tension, the coordication degree is high, operation is easy. It is worth of the clinical promotion.