儿童腰椎穿刺术后腰痛原因及平卧时伸展下肢对腰痛影响

Factor analysis of backache after lumbar puncture in children and the therapeutic effect of stretching lower limbs in lying down on backache

目的 通过分析儿童腰椎穿刺术后腰痛的原因,探讨腰穿术后平卧时伸展双下肢对腰痛的影响。方法 回顾性分析2013-01-01-2021-09-01泰安市妇幼保健院行诊断性腰椎穿刺术的2 238例患儿临床资料,随机分为观察组(n=980)和干预组(n=1 258),比较穿刺针大小、穿刺次数、颅内压高低与腰痛发生的相关性。并对干预组患儿进行平卧时自由伸展双下肢,观察比较2组患儿腰痛的发生率、持续时间及程度,数据处理采用SSPS 20.0,统计学分析采用χ^(2)检验和Fisher精确检验。结果 干预组患儿腰痛发生率为6.4%(81/1 258),低于观察组患儿腰痛发生率10.3%(101/980),差异有统计学意义,χ^(2)=9.331,P=0.002;2组腰穿术后腰痛出现的时间比较差异无统计学意义,χ^(2)=3.311,P=0.191;腰椎穿刺术后腰痛持续时间及腰椎穿刺术后腰痛程度,干预组与观察组比较差异有统计学意义,χ^(2)值分别为17.242和13.906,均P<0.001。结论 腰椎穿刺术前适当降低颅内压可减少术后腰痛发生率。腰穿术后平卧时自由伸展双下肢可显著降低腰痛的发生率,并明显缩短腰痛的时间及缓解疼痛程度,临床应予高度重视。

Objective To analyze the causes of low back pain after lumbar puncture in children, and to explore the influence of stretching lower limbs on low back pain after lumbar puncture.Methods Retrospective analysis was made on 2238 children who underwent diagnostic lumbar puncture from January 1,2013 to September 1,2021.They were randomly divided into the observation group(n=980) and the intervention group(n=1 258).The correlation between the size of puncture needle, puncture times, intracranial pressure and the occurrence of low back pain was compared.The children in the intervention group were free to stretch their lower limbs while lying down, and the incidence, duration and degree of low back pain were observed and compared between the two groups.Data were processed by SSPS 20.0 software, and statistical analysis was performed by chi-square test and Fisher exact test.Results The incidence of lumbago in the intervention group was 6.4%(81/1 258) significantly lower than that in the observation group[10.3%(101/980)],and the difference was statistically significant(χ^(2)=9.331,P=0.002).There was no significant difference in the occurrence time of lumbago between the two groups(χ^(2)=3.311,P=0.191).The duration and degree of lumbago after lumbar puncture were significantly different between the intervention group and the observation group(χ^(2)=17.242;13.906,all P<0.001).Conclusions Proper reduction of intracranial pressure before lumbar puncture in children can reduce the incidence of postoperative low back pain.Free extension of lower limbs in supine position after lumbar puncture can significantly reduce the incidence of lumbago, shorten the time of lumbago and relieve the degree of pain, which should be highly valued in clinical practice.