连续采集兔脑脊液新方法

目的:探索一种连续无血污染兔脑脊液采集新技术。方法:以新西兰兔为实验对象,以冠状缝为标志,沿正中线向后1.0cm,旁开0.3cm为操作点,使用牙科钻钻孔,腰麻穿刺针穿刺置管,抽取脑脊液。结果:总成功率约94.7%。不同时间点抽取6次,均能顺利采集到脑脊液。新西兰兔的脑脊液可抽取总量大约在0.8ml-1.6ml之间。结论:此方法操作简便,成功率高,适合连续多次采集脑脊液。     

巴氯芬注射液Beagle犬腰椎穿刺置管多次鞘内注射局部刺激性研究

目的模拟临床给药途径,Beagle犬腰椎穿刺置管多次鞘内注射巴氯芬注射液,观察其局部刺激性,同时进行犬行为学观察,为巴氯芬注射液安全性评价提供依据。方法12只Beagle犬分为假手术组,生理盐水对照组,巴氯芬给药组。行腰椎穿刺置管,使用单通道微量注射泵泵入给药,给药剂量为1000μg/d,生理盐水对照组给予生理盐水0.5mL,连续给药7d,恢复期7d。每日进行行为学观察,给药结束及恢复期结束时每组麻醉2只动物,取给药部位脊髓进行组织病理学检查。结果给药及恢复期期间动物行为未见异常,给药结束时各组均有部分动物观察到置管处表皮感染现象,进行局部消毒处理后在恢复期第3天恢复正常。组织病理学检查发现给药及恢复期结束时各组动物脊髓均可见血管周围炎细胞浸润或脊髓内钙盐沉积,各组无差别。给药结束时巴氯芬组1例动物脊膜处有肉芽组织形成,判定与置管操作有关。结论巴氯芬注射液Beagle犬腰椎穿刺置管连续7d鞘内注射,给药剂量为1000μg/d对脊髓无局部刺激性作用,动物行为也未见异常。     

超声多普勒技术在323例危重症患者颈内静脉穿刺置管术中的应用

目的:探讨超声多普勒技术在危重症惠者颈内静脉穿刺置管中的临床应用价值.方珐:选取323例预计颈内静脉穿刺困难的危重症患者,在超声引导下行右颈内静脉穿刺置管,记录穿刺时间、一次穿刺置管成功率、二次以上穿刺置管成功率及并发症发生例数.结果:323例患者均在超声引导下行右颈内静脉穿刺置管成功.无一例因穿刺失败改行其他部位中心静脉穿刺.超声多普勒引导穿刺置管操作时间184.6±20.5s.超声多普勒引导一次穿刺置管成功率93%.超声多普勒引导二次以上穿刺置管成功率100%.并发症发生率4.64%.结论:应用超声多普勒技术引导危重症怠者颈内静脉穿刺置管.缩短了置管时间,减少了穿刺次数,提高了一次穿刺成功率.     

DSA技术在恒河猴脑脊液动态采集中应用

探索数字减影血管造影(digital subtraction angiography,DSA)插管技术在恒河猴(Macaca mulatta)脑脊液动态采集中的应用。将28只恒河猴作为实验动物,随机分为实验组和对照组,每组14只,经左前肢静脉推注3%戊巴比妥钠溶液全麻后,常规剔除背部脊柱周围体毛、消毒,实验组从穿刺开始就在DSA技术下行腰椎间隙穿刺,对照组直接行腰椎间隙穿刺,将硬膜外麻醉导管经腰椎蛛网膜下腔送至枕大池并埋置泵。对不同穿刺方法的结果数据进行χ2检验;神经功能参照改良Tarlov评分标准,切口采用改良的切口愈合等级评分标准。实验组经腰椎间隙穿刺蛛网膜下腔全部成功;对照组8只穿刺成功,6只穿刺失败;所有动物埋置泵均能从泵中采集到无色透明的脑脊液;术后恒河猴均于当天恢复正常。在DSA技术下经腰椎间隙穿刺蛛网膜下腔并埋置泵,成功率高,操作简便、安全性好,可行性强;通过埋置的泵采集脑脊液,快速省时,可实现在动物清醒时、全生理状态下对脑脊液进行动态多次采集,有助于提高非人灵长类实验动物的福利,由于采样导管置于枕大池,采集到的脑脊液样品质量有保证,可用于研究缺血性脑卒中发生机制,满足检验需要,具有一定的实用价值。     

多普勒彩超引导桡动脉穿刺置管术的临床应用

目的观察多普勒彩超引导桡动脉穿刺置管的临床效果。方法将拟行全麻手术且需行桡动脉穿刺置管术患者100例随机分为A组和B组。A组采用脉搏搏动法行桡动脉穿刺置管,B组采用多普勒彩超引导行桡动脉穿刺置管。两组均由低年资医师完成操作,并记录首次穿刺成功率、首次穿刺时间、总穿刺成功率、总穿刺时间。结果多普勒彩超引导下桡动脉穿刺首次成功率及总穿刺成功率均高于动脉搏动法,且总穿刺时间短于动脉搏动法。结论多普勒彩超引导桡动脉穿刺技术有助于提高低年资操作者桡动脉穿刺的成功率和效率。     

腰椎置管治疗隐球菌性脑膜炎4例并文献复习

目的 观察早期腰椎置管引流加鞘内注射两性霉素B治疗伴有恶性高颅压隐球菌性脑膜炎的临床效果及探讨临床应用的可行性.方法 详细分析和归纳整理了我科应用腰椎置管法治疗的4例隐球菌性脑膜炎患者的临床资料.结果 4例患者经早期腰椎置管引流加鞘内注射两性霉素B治疗后临床症状迅速改善.经联合治疗后,痊愈3例,好转1例,4例患者随访至今均无复发.结论 早期腰椎置管引流加鞘内注射两性霉素B治疗隐球菌性脑膜炎能有效的降低隐球菌脑膜炎患者的高颅压,改善临床症状,提高疗效.     

超声引导下穿刺置管引流治疗肝脓肿的疗效分析

目的:探讨超声引导下穿刺置管引流治疗肝脓肿的临床疗效。方法:回顾性分析本院2012-2013年56例肝脓肿住院患者超声引导下穿刺置管引流治疗的临床资料。结果:56例患者行超声引导下穿刺置管引流治疗,其中3例多发脓肿行2次穿刺置管治疗,其余均一次穿刺置管成功,未出现出血、胆漏、周围脏器损伤等并发症,本组患者手术前后体温、白细胞数及脓肿面积比较均有统计学意义(P0.01)。24例体温升高患者中,21例术后3天内恢复正常,3例仍有升高;41例白细胞数升高患者中,29例术后3天内恢复正常,12例仍有增高;56例患者术后脓肿面积均明显减小,该组患者腹痛、肝区叩痛等临床症状均明显缓解。结论:超声引导下穿刺抽吸及置管引流治疗肝脓肿是一种简单方便、安全可靠、创伤小、明显有效的局部治疗方法,操作者需要充分作好术前准备,严格把握适应症,严谨操作步骤并结合全身抗生素治疗可以明显改善患者发热症状,有效降低患者白细胞及中性粒细胞,明显缩短治疗周期,提高治愈率。     

锁骨下静脉穿刺置管术在神经外科重症患者的应用的临床效应 （附300 例病例报告）

目的:分析探讨锁骨下静脉穿刺置管术在重症神经外科疾病中的应用的临床效应。方法:选择锁骨下静脉,首选右侧,如果穿刺右侧失败改为左侧。穿刺成功后用扩张器扩皮,最后顺导丝置入导管,根据患者身高置管长度为12～15 cm,局部缝合固定,外敷纱布封闭或用一次性贴膜封闭。静脉留置管接三通静脉输液管。结果:286例首次穿刺右侧成功282例,4例失败后改选左侧成功。静脉导管留置时间最短3天,最长45天,留置时间平均为18天。结论:锁骨下静脉穿刺置管术在神经外科中抢救治疗重症患者是十分便利、有效的措施。锁骨下静脉穿刺置管术较其他深静脉穿刺置管如股静脉、颈内静脉和颈外静脉穿刺置管术及PICC相比较,更利于护理并具有费用低廉的优点。其方便、有效、经济的特点十分利于临床应用。     

EICU中心静脉导管相关性感染的危险因素分析及护理对策

目的 探讨急诊重症监护病房(EICU)患者深静脉置管后,中心静脉导管相关性感染的危险因素及护理对策.方法 采用表单式记录方法,记录置管前手消毒、置管时机、置管部位、置管顿次、置管时间、穿刺点护理、输液接头、敷料选择等内容.结果 通过对64例置管患者的—预,其导管相关性感染的发生率为7.8％,其危险因素主要与置管技术、无菌原则、插管部位、使用时间、导管维护等有关.结论 中心静脉导管在临床使用中由于多种因素的影响感染的发生难以避免,针对其危险因素,采用表单式的护理方法,可以提醒操作者及维护者在置管前的准备、置管中的配合及置管后的护理方法,从而降低感染的发生率.     

置管引流大剂量乙醇分次硬化治疗肝肾巨大囊肿的新探索

目的：探讨经皮穿刺置管引流及大剂量乙醇分次硬化治疗肝肾巨大囊肿的疗效及安全性。方法选取最大直径≥8 cm肝脏或肾脏巨大囊肿,囊肿患者分为两组,对照组35例,采用PTC针穿刺一次性大剂量无水乙醇囊内冲洗法。研究组38例,采用置管引流分次大剂量无水乙醇冲洗法。两组治疗方法比较术中术后不良反应的发生率。术后随访一年,观察囊肿直径变化并比较两组间的疗效差别。结果置管引流分次硬化治疗组术后疗效优于对照组,术中术后不良反应发生率低于对照组。结论应用置管引流大剂量乙醇分次硬化治疗肝肾巨大囊肿疗效更显著,更安全可靠。     

Spinal puncture headache

Headache is the commonest complication of spinal puncture. There is no significant difference in the incidence of headache after lumbar puncture, whether or not the puncture is followed by injection of an anesthetic agent. The sequence of events leading to postlumbar puncture headaches is probably (1) decreased volume of cerebrospinal fluid with lowered pressure; (2) increased differential between the pressure of the cerebrospinal fluid and the intracranial venous pressure; (3) dilation of venous structures with increase in brain volume; and (4) production of tension on the pain sensitive areas in the cranium. Prevention of postlumbar puncture headache consists largely in attempts to avoid the development of the pressure differential between that of the cerebrospinal fluid and intracranial venous pressure. Treatment consists of analgesics, hydration and attempts to restore normal cerebrospinal fluid pressure.     

Calculating lumbar puncture depth in children

Lumbar puncture was performed in 195 children and the depth of needle was recorded. Our results show that the depth of lumbar puncture necessary to obtain uncontaminated cerebrospinal fluid correlates best with the child's weight. The simple formula: mean depth of insertion (cm) = 1.3 + 0.07 x body weight (kg), can be used to estimate the depth of lumbar puncture of children older than 3 months. The depths of lumbar puncture of children younger than 3 months are mostly 1.0-1.5 cm.     

Post-Lumbar Puncture Headache Etiology and Management

Headache following a lumbar puncture is a common and often debilitating syndrome. Continued leakage of cerebrospinal fluid from a puncture site decreases intracranial pressure, which leads to traction on pain-sensitive intracranial structures. The headache is characteristically postural, often associated with nausea and optic, vestibular, or otic symptoms. Although usually self-limited after a few days, severe postural pain can incapacitate the patient. Management is mainly symptomatic, but definitive treatment with the epidural blood patching technique is safe and effective when done by an expert operator.     

In vivo influences on cerebrospinal fluid amino acid levels

The concentration of 19 amino acids and ethanolamine in two independent groups (n = 36, n = 19) of normal human cerebrospinal fluid (CSF) samples were measured by high performance liquid chromatography. Age, sex, time of lumbar puncture, position during lumbar puncture, protein and glucose content of the CSF were monitored and the influence of these parameters on CSF amino acid levels was determined. Hypotheses formulated after observing measurements from the first group of CSF samples were tested against the second group of CSF samples using conservative statistics. The main finding was a positive correlation between CSF glucose and CSF glutamate levels.     

Taurine in plasma and CSF: a study in healthy male volunteers

In order to explore the interrelationship between plasma and cerebrospinal fluid taurine concentrations, three consecutive 6-ml fractions of cerebrospinal fluid were drawn from 30 healthy male volunteers in the early morning after 8 h in the fasting condition. Repeated plasma samples were drawn over 24 h the day before lumbar puncture. Taurine in plasma and cerebrospinal fluid was determined by high performance liquid chromatography. The subjects were categorized as extensive or poor metabolizers with respect to the cytochrome P450 2D6 genotype. The taurine cerebrospinal fluid/plasma ratio at 8 a.m. was negatively influenced by the plasma taurine concentration at 4 p.m. the previous day. It was also negatively influenced by body mass index and positively by the intraspinal pressure. Three poor metabolizers of cytochrome P450 2D6 had higher plasma taurine areas under the curve than 27 extensive metabolizers. Hypothetically, cytochrome P450 2D6 influences the transport of taurine across the blood–brain barrier.     

β-endorphin levels after intrathecal infusion of iodinated contrast media

Modifications in β-endorphin levels in cerebrospinal fluid have been described following lumbar puncture and metrizamide injection. Cerebrospinal fluid (CSF) samples were obtained from 19 patients before and after lumbar myelography. Two radioimmunoassays were used. One was a commercial kit; and the other one (developed in our laboratory) used a chromatographic removal from β-lipotrophin. No definite variation of β-endorphin was observed after myelography, using either the commercial kit or a more sophisticated procedure. Some controls were prepared by adding metrizamide or Iopamidol in vitro to CSF samples in order to evaluate a non specific effect of these contrast media. The results obtained with these controls suggest that the discrepancy of results may be explained simply by assay artifacts due to drug interferences when using the commercial methods.     

Leptomeningeal carcinomatosis presenting as eosinophilic meningitis

The case of a 67-year-old man with underlying carcinomatous meningitis who presented with meningismus and cerebrospinal fluid (CSF) eosinophilia is reported. CSF eosinophilia can reflect a number of underlying conditions; however, carcinomatous meningitis is not generally considered. In this case, studies for bacterial, fungal and parasitic agents were negative. Cytologic examination of a lumbar puncture specimen revealed malignant epithelial cells in an inflammatory background. When unexplained eosinophilia is found in the CSF, a thorough search for coincident meningeal carcinomatosis should be undertaken.     

Pathogenesis of the "sentinel headache" preceding berry aneurysm rupture.

Pathologic examination in a case of fatal intracerebral hemorrhage from a berry aneurysm showed that the "sentinel" or warning headache in this patient was due to the leakage of blood into the subarachnoid space through a previous small tear in the wall of her saccular aneurysm. Oribital pain, transient, dysphasia, dizziness and, later, meningismus might have prompted the performing of a lumbar puncture to determine the presence of blood in the cerebrospinal fluid. This type of event is the likely pathogenetic mechanism for the premonitory headache that may precede a lethal rupture of a saccular aneurysm.     

Measuring opening pressure in lumbar puncture--a new method]

Determination of the opening pressure (OP) during diagnostic lumbar puncture (LP) yields additional information that may impact on treatment and prognosis in disorders affecting the central nervous system (e.g. meningitis). Established methods contain systematic errors as well as risks to the patient. We therefore present a new procedure that allows measurement of the OP by timing the flow of cerebrospinal fluid through a capillary attached to an LP needle. A resistance located between needle and capillary slows down the flow of cerebrospinal fluid so that it becomes independent of the capillary forces acting on it. The time required for the fluid to travel between two marks on the capillary (defining a given volume) can be used to calculate the flow. Since the combined resistance of needle and resistance can be calibrated, the pressure driving the flow--in this case the opening pressure--can be calculated. A simple model was used to evaluate the impact of different resistances and different needles on OP determination. The effects of cellular elements and proteins in the CSF are discussed.