What Are The Possible Reactions During The Operation Of The Lumbar Puncture Needle? How To Deal With It?

What are the possible reactions during the operation of the lumbar puncture needle? How to deal with it?

1. Low intracranial pressure syndrome: The pressure of the cerebrospinal fluid in the lateral position is below 0.58-0.78kPa (60-80mm water column), which is more common. The puncture needle is too thick, the puncture technique is unskilled, or the postoperative waking up too early, causing the continuous outflow of cerebrospinal fluid from the spinal puncture hole. The headache is obviously aggravated after sitting up, and the severe cases are accompanied by nausea and vomiting or dizziness, fainting, and calming down. Headaches can be alleviated or relieved when lying down or head down. A few of them may still have disturbances of consciousness, mental symptoms, meningeal irritation, etc., lasting for about one to several days. Therefore, fine needle puncture should be used. After the operation, go to the pillow to lie down (preferably prone) for 4-6 hours, and drink more boiled water (avoid drinking strong tea, sugar water) to often prevent it. If it has occurred, except instruct the patient to continue lying down In addition to drinking more boiled water, you can also inject 10-15ml of distilled water or 500-1000ml of 5% grape saline intravenously as appropriate, 1-2 times per day, and it can often be cured within a few days. You can also inject 20-30ml of normal saline into the spinal canal or epidural by lumbar puncture again to eliminate the negative pressure in the epidural space to prevent the cerebrospinal fluid from leaking.

2. Cerebral herniation: When the intracranial pressure increases (especially the posterior fossa and temporal space-occupying lesions), when the lumbar puncture discharges too much and too quickly, the brain herniation can occur at the time of the puncture or within a few hours after the puncture. Therefore, strict attention and prevention should be taken. If necessary, you can quickly inject a dehydrating agent such as 250ml of 20% mannitol solution intravenously before ordering, puncture with a fine needle, and slowly drip out a few drops of cerebrospinal fluid for laboratory examination. If misfortune occurs, corresponding rescue measures should be taken immediately, such as intravenous injection of 20% mannitol 200-400ml and hypertonic diuretic dehydrating agent, etc., if necessary, puncture and drainage from the ventricle and rapid injection of normal saline 40 from the spinal canal. -80ml, but it is generally harder to work.

3. Sudden aggravation of the original spinal cord and spinal nerve root symptoms: It is more common in spinal cord compression, which is caused by changes in the pressure balance between the spinal cord, nerve roots, cerebrospinal fluid and lesions in the spinal canal due to pressure changes after lumbar puncture. It can aggravate symptoms such as radicular pain, paraplegia, and urinary and urinary disorders. In high cervical spinal cord compression, dyspnea and sudden arrest can occur. If the above symptoms are not serious, 30-50ml of normal saline can be injected into the spinal canal first: no effect In good time, please consider surgical treatment in emergency.

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