蛛网膜下腔出血持续腰大池引流的护理

Nursing of continuous lumbar cisterna drainage for subarachnoid hemorrhage

目的 总结持续腰大池外引流对蛛网膜下腔出血的护理方法.方法 对228例蛛网膜下腔出血患者进行持续腰大池外引流术,观察置管引流期间的护理问题,总结相应的护理方法.结果 本组228例患者进行持续腰大池外引流术后意识障碍、头痛、呕吐、精神症状明显缓解;平均住院天数为30 d,引流管留置时间为5～7 d,共发生堵管5例,4例经冲洗后引流通畅,1例重新置管并引流通畅;发生颅内感染1例,经细菌培养证实为颅内金黄色葡萄球菌感染,根据药敏选择敏感抗生素治疗后感染得到控制;无一例发生低颅压综合征.所有患者脑脊液由淡红色逐渐转为无色澄清后好转出院.结论 持续腰大池外引流治疗蛛网膜下腔出血简单、安全、有效,精心观察和护理能有效降低并发症的发生率,提高治疗效果,促进患者康复.

Objective To summarize the nursing methods of continuous lumbar cisterna drainage for subarachnoid hemorrhage. Methods Two hundred and twenty-eight patients with subarachnoid hemorrhage accepted continuous lum- bar cisterna drainage.The nursing problems during indwelling catheter were observed and the correspondent nursing methods were summarized. Results Among all these patients,disturbance of consciousness,headache,vomit,and psychi- atric symptoms were remarkably alleviated after adopting continuous lumbar cisterna drainage.The average hospital stay was 30 days.The period of indwelling catheter lasted 5 to 7 days.The catheters were blocked in 5 cases,of which catheters became smooth after rinse in 4 cases,and the rest one was treated by indwelling catheter again for unobstruct- ed drainage.Only one patient occurred with intracranial infection caused by Staphylococcus aureus after bacterial cul- ture.The infection was controlled after providing with sensitive antibiotics based on outcome of drug sensitive test.No case presented with intracranial hypotension syndrome.The color of cerebrospinal fluid in all participants turned to col- orless and clear from light red,and then all of them were discharged from hospital. Conclusion In the treatment of sub- arachnoid hemorrhage,continuous lumbar eisterna drainage is simple,safe and effective.Meticulous observation and nursing can effectively decrease the incidence of complication,improve therapeutic effect,and promote recovery.