Tom qab- lumbar puncture taub hau yog ib qho teeb meem tshwm sim hauv kev kho mob, nrog rau qhov tshwm sim ntau txog 30%-40% hauv cov txheej txheem ib txwm muaj. Hom mob taub hau no feem ntau tshwm sim raws li qhov chaw - nws hnyav dua thaum tus neeg mob zaum lossis sawv, thiab txhim kho thaum pw. Nws tuaj yeem kav ntev li ob peb hnub lossis ntau lub lis piam, cuam tshuam rau tus neeg mob lub neej zoo. Thiab tag nrho cov no feem ntau nyob ntawm lub thickness ntawm rab koob.

Pathogenesis ntawm PDPH

Lub ntsiab lus ntawm post- mob taub hau dural puncture yog cerebrospinal kua to. Thaum tus txha caj qaum dhau los ntawm dura mater thiab arachnoid mater, qhov ua txhaum me me yog sab laug. Yog hais tias qhov ua txhaum cai loj los yog tsis kho kom zoo, cov kua cerebrospinal yuav tsis tu ncua nkag mus rau hauv qhov chaw epidural, ua rau txo qis hauv intracranial siab. Lub paj hlwb poob qhov kev txhawb nqa ntawm cov kua cerebrospinal thiab hloov mus rau hauv qab, rub qhov mob - cov txheej txheem rhiab nyob rau hauv lub pob txha taub hau (xws li meninges thiab cov hlab ntsha), yog li ua rau mob taub hau.

Lub Revolutionary contribution of Fine Needles

Nws yog qhov tseeb raws li cov txheej txheem no uas cov neeg kho mob tau pib tshawb nrhiav txoj hauv kev los txo qhov sib txawv hauv dura mater. Txoj kev daws teeb meem yog - siv cov koob nyias nyias.

Cov ntaub ntawv pov thawj pom tau tias thaum txoj kab uas hla ntawm tus txha caj qaum txo qis los ntawm 22G txog 25G, qhov tshwm sim ntawm PDPH tuaj yeem poob qis los ntawm 20% -30% mus rau qis dua 5%. Thiab thaum siv 27G cwj mem-point koob, daim duab no tuaj yeem txo qis qis dua 1%. Qhov no yog vim:

• Qhov loj ntawm qhov chaw puncture tau txo qis:Tus ntoo khaub lig- ntu ntu ntawm 27G koob tsuas yog kwv yees li ib -peb peb ntawm 22G koob, uas ua rau muaj qhov txo qis hauv kev puas tsuaj rau dura mater.
• Cov ntaub so ntswg zoo dua:Tom qab cov koob zoo tau muab tso, cov elastic fibers ntawm dura mater muaj feem yuav thim rov qab thiab kaw, ua tiav cov txiaj ntsig zoo dua.
• Kev txhawb nqa ntawm tus cwj mem -point tsim:Raws li tau hais ua ntej, tus cwj mem -point koob thawb ntau dua li txiav cov fibers, ntxiv kom txo tau cov kua dej.

Cov Kev Sib Tw Ua Haujlwm ntawm Cov Koob Zoo

Txawm li cas los xij, koob zoo tsis zoo tag nrho. Hauv kev ua haujlwm tiag tiag, 27G koob muaj qhov yooj yim heev thiab nws yooj yim rau kev khoov thaum lub sijhawm ua haujlwm, tshwj xeeb tshaj yog thaum ntsib cov pob txha pob txha lossis ligament calcification. Cov kws kho mob tuaj yeem ntsib "kev hnov ​​​​mob tactile" - lawv tsis tuaj yeem pom meej qhov kev hnov ​​​​qab zoo li lub koob taub hla dhau ntawm txhua txheej ntawm cov ntaub so ntswg. Tsis tas li ntawd, vim nws txoj kab uas hla me me heev, cov kua cerebrospinal ntws rov qab qeeb heev, thiab qee zaum nws yuav siv sijhawm ntau dua 30 vib nas this kom pom cov kua cerebrospinal poob, uas yog kev sim siab ntev thiab cov txheej txheem.

Clinical Application Strategy

Muab qhov zoo ntawm cov koob zoo, cov lus qhia thoob ntiaj teb tam sim no feem ntau pom zoo: Nyob rau hauv niaj hnub kev kuaj mob lumbar punctures thiab cov txheej txheem txha caj qaum, 25G lossis finer tip spinal needles yuav tsum nyiam dua. Rau cov neeg muaj kev pheej hmoo siab (xws li cov poj niam hluas, cov poj niam cev xeeb tub, thiab cov uas muaj keeb kwm yav dhau los ntawm PDPH), kev siv 27G koob yuav tsum tau ua raws li nruj me ntsis.

Tau kawg, nyob rau qee qhov xwm txheej tshwj xeeb, xws li thaum nws yuav tsum tau ceev cov kua dej ntau hauv cerebrospinal los yog txhaj cov tshuaj muaj kuab heev, nws tsim nyog me ntsis nce qhov loj me mus rau 22G-24G. Lub ntsiab lus tseem ceeb yog tias cov kws kho mob yuav tsum nco ntsoov "qhov tsim nyog raug mob tsawg kawg nkaus" raws li lub hauv paus ntsiab lus. Raws li qhov ua tau raws li qhov yuav tsum tau ua, lawv yuav tsum xaiv cov koob thinnest tau.

Nws tuaj yeem hais tias qhov kev kho kom zoo ntawm qhov loj ntawm cov koob txha caj qaum sawv cev yog qhov tseem ceeb tshaj plaws kev nyab xeeb kiv puag ncig hauv keeb kwm ntawm cov txheej txheem lumbar puncture. Qhov no rab koob, nyias nyias li plaub hau, tsis tsuas yog alleviates tus neeg mob qhov mob tab sis kuj boosts kev soj ntsuam kev ntseeg siab ntawm tag nrho cov kev qhuab qhia.