Dab tsi yog cov khoom ntawm lumbar puncture koob

Lub lumbar puncture tuaj yeem siv rau kev kuaj mob thiab kho. Txhawm rau ua qhov txheej txheem no kom nyab xeeb thiab ua tau zoo, cov kws kho mob yuav tsum nkag siab txog cov contraindications rau lumbar puncture, cuam tshuam lub cev, thiab txoj hauv kev kom txo qis kev pheej hmoo ntawm cov teeb meem. Txawm hais tias lumbar puncture tsis tshua muaj kev phom sij, thaum nws tshwm sim, nws tuaj yeem ua rau mob hnyav thiab muaj peev xwm ua neej nyob - hem. Paub txog qhov qhia, contraindications thiab kev ua haujlwm zoo ntawm lumbar puncture tuaj yeem txo qhov kev pheej hmoo.

Lumbar puncture ntaus ntawv

Cov khoom lag luam lumbar puncture suav nrog cov cuab yeej tsim nyog rau lumbar puncture: lumbar puncture koob nrog ib rab koob, cov tshuaj tua kab mob ntawm daim tawv nqaij, phuam phais, sau raj thiab manometer. Lub koob ntsuas 22 - yog qhov zoo dua vim tias lub qhov me me txo qhov kev pheej hmoo ntawm CSF to. Feem ntau, cov menyuam mos siv 1.5 - inch (3.8 cm) koob, menyuam yaus siv 2.5 - inch (6.3 cm) koob, thiab cov neeg laus siv 3.5 - inch (8.9 cm) koob.

lub cev txoj hauj lwm

Tus neeg mob yuav tsum tau muab tso rau hauv ib lub lateral los yog zaum. Txhawm rau kom tau txais qhov tseeb qhib siab thiab txo qhov kev pheej hmoo ntawm post - puncture headache, txoj hauj lwm sab nraud yog nyiam. Tsis yog txhua tus neeg mob tuaj yeem tau txais lumbar puncture nyob rau hauv txhua txoj haujlwm, yog li cov kws kho mob kawm ua cov txheej txheem nrog tus neeg mob pw ntawm sab laug, sab xis, thiab sab xis. Thaum tus neeg mob' qhov yooj yim txoj hauj lwm raug tsim, tus kws kho mob yuav tsum qhia tus neeg mob kom coj ib tug fetal txoj hauj lwm los yog arch lub duav" zoo li ib tug miv" kom nce qhov chaw ntawm cov txheej txheem spinous. Thaum tus neeg mob nyob rau hauv ib qho chaw zaum, lub lumbar qaum yuav tsum tau perpendicular mus rau lub tabletop, thiab thaum tus neeg mob nyob rau hauv ib tug lateral txoj hauj lwm, lub lumbar qaum yuav tsum nyob rau tib lub sij hawm mus rau lub tabletop.

thaj chaw

Kos ib txoj kab nruab nrab ntawm cov ciam teb sab saud ntawm iliac crests ntawm ob sab, sib tshuam cov kab nruab nrab dhau los ntawm cov txheej txheem L4 spinous. Ntxig lub koob rau hauv qhov chaw nruab nrab ntawm L3 thiab L4 lossis L4 thiab L5, vim tias cov ntsiab lus no nyob hauv qab ntu ntu ntawm tus txha caj qaum. Cov kws kho mob yuav tsum tau saib xyuas thaj chaw ua ntej kom tsis muaj menyuam ntawm daim tawv nqaij thiab txhaj tshuaj loog hauv zos, vim tias cov haujlwm no muaj peev xwm ua kom tsis pom qhov chaw. Siv daim tawv nqaij los kos qhov chaw raug.

Kev npaj ua ntej puncture

Tom qab tus kws kho mob tso cov hnab looj tes tua kab mob, tua cov tawv nqaij nrog cov tshuaj tua kab mob tsim nyog (povidone - iodine lossis chlorhexidine - uas muaj cov tshuaj), pib los ntawm qhov chaw thiab nthuav tawm sab nraud hauv lub voj voog. Tom qab ntawd npog nrog tshuaj tua kab mob.

Mob nyem thiab sedation

Lub lumbar puncture tuaj yeem ua rau mob thiab tsis xis nyob, thiab qhov tsawg kawg nkaus ntawm cov tshuaj loog hauv zos yog qhov tsim nyog. Yog tias lub sijhawm tso cai, cov kws kho mob tuaj yeem siv tshuaj loog tshuaj loog rau cov neeg mob ua ntej ntxuav lawv cov tawv nqaij. Tom qab daim tawv nqaij raug tshuaj tua kab mob thiab npog nrog ib daim ntaub, cov tshuaj loog hauv zos tuaj yeem txhaj tshuaj subcutaneously, thiab siv cov tshuaj sedatives thiab tshuaj tua kab mob.

lumbar puncture

Tom qab pom cov cim tseem ceeb dua, tus kws kho mob ntxig ib rab koob nrog ib rab koob ntawm lub midline txoj hauj lwm thiab sab sauv ntawm cov txheej txheem spinous tom ntej. Lub koob yog tig mus rau lub taub hau ntawm li 15 degrees, uas zoo li yuav tig mus rau kev taw qhia ntawm tus neeg mob' s umbilicus. CSF to tuaj yeem ua rau mob taub hau tom qab -, thiab cov ntaub ntawv tsis ntev los no qhia tias kev siv" xaum - zoo li" koob tuaj yeem txo qhov kev pheej hmoo ntawm kev mob taub hau vim tias lawv tso cai rau cov fibers ntawm lub hnab dural kom xoob yam tsis tau txiav lawv. Yog tias cov koob beveled feem ntau siv, lub bevel ntawm rab koob yuav tsum nyob rau hauv lub dav hlau sagittal, uas tseem tso cai rau cov fibers sib npaug mus rau tus txha caj qaum kom nthuav tawm yam tsis muaj severing lawv.

Yog tias rab koob tau muab tso rau hauv txoj haujlwm kom raug, rab koob yuav tsum tau hla ntawm daim tawv nqaij, cov ntaub so ntswg subcutaneous, supraspinous ligament, interspinous ligament ntawm cov txheej txheem spinous, ligamentum flavum, thiab qhov chaw epidural (xws li lub hauv siab vertebral venous plexus, dura mater, thiab arachnoid). ) nyob rau hauv kev txiav txim. , nkag mus rau qhov chaw subarachnoid thiab nyob nruab nrab ntawm cov hauv paus hniav ntawm cauda equina. Raws li rab koob hla dhau ligamentum flavum, tus kws kho mob tuaj yeem hnov ​​​​qhov kev nkag siab ntawm kev tawg. Lub sijhawm no, rab koob tseem ceeb yuav tsum tau rub tawm 2 hli los saib seb puas muaj cov kua dej cerebrospinal tawm. Yog tias qhov puncture tsis ua tiav thiab kov cov pob txha, tshem lub koob txhaj tshuaj mus rau cov ntaub so ntswg subcutaneous, tab sis tsis txhob thim tawm ntawm daim tawv nqaij, kho cov kev taw qhia thiab ntxig rau rab koob dua. Thaum lub koob nkag mus rau qhov chaw subarachnoid, muaj CSF outflow. Yog tias muaj kev raug mob thaum lub sij hawm puncture, CSF tej zaum yuav muaj ntshav me ntsis. Thaum CSF tau sau, CSF yuav tsum pom tseeb thiab tsis muaj ntshav, tshwj tsis yog tias muaj cov ntshav subarachnoid. Yog tias qhov ntws ntawm CSF tsis zoo, rab koob yuav tig tau 90 degrees vim tias qhov qhib ntawm rab koob yuav raug thaiv los ntawm cov paj hlwb.

Yog tias koj muaj lus nug, thov hu rau peb. Peb lub tuam txhab tuaj yeem tsim ntau yam koob txhaj tshuaj, koob tshuaj kho mob, koob txhaj tshuaj, koob tshuaj hypodermic, koob txhaj tshuaj, koob tshuaj tiv thaiv kab mob, koob txhaj tshuaj, koob txhaj tshuaj, koob tshuaj tua tsiaj, koob xaum koob, koob ovum khaws koob, koob txhaj tshuaj, thiab lwm yam Yog tias koj xav tau kev kho. koob cov khoom, thov hu rau peb. Peb tos ntsoov rau koj qhov kev nug! Qhov zoo ntawm cov khoom tsim nyob rau hauv peb lub Hoobkas yuav txaus siab rau koj!

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