腰椎穿刺檢查後病人平躺舒適度之改善專案

腰椎穿刺檢查為診斷中樞神經系統感染常見檢查，藉由抽取少量的腦脊髓液檢查或引流多餘的腦脊髓液，以達到疾病診斷和測量腦壓為目的。檢查後必須採平躺姿勢6至8小時，且頭部不可睡枕頭，以免造成頭痛的後遺症，然而此種姿勢讓病人感到肩頸腰背酸痛和解尿困難等不舒適問題，影響了病人平躺意願。經調查發現：護理人員未能主動評估及介入處理病人腰背酸痛問題、缺乏病人臥床期間的活動指引和合適的翻身輔具，因而造成所有腰椎穿刺檢查後病人均抱怨持續平躺的不適。藉由修訂腰椎穿刺檢查後護理照護標準、籌劃在職教育、挑選購置合適的枕頭和翻身輔具及制定腰椎穿刺檢查後病人平躺舒適監測指標等方案後，提升腰椎穿刺檢查後病人平躺舒適度至94.1%，達到專案目標，對臨床護理工作有顯著幫助，並提升照護品質。

關鍵字

腰椎穿刺檢查；舒適度；穿刺後頭痛

並列摘要

Lumbar puncture is a common examination for diagnosis of infection of central nervous system. During the examination, some cerebrospinal fluid is extracted and the redundant cerebrospinal fluid is drained. After the examination, the patients must lie on the back for 6 to 8 hours, and a pillow is not allowed during the period to avoid the sequelae of headache. However, such a posture often makes the patients uncomfortable, causing aching shoulders, neck, waist, and back as well as difficult urination, which reducing the patients' willingness to lie on the back. According to the investigation, lack of caregivers' active evaluation of and solutions to the aching waist and back of the patients, and lack of guidance for the activities after the examination, and lack of appropriate turn-over tools resulted in discomfort of lying on the back after examination. After establishing the care standards post-lumber puncture examination, planning an in-service education, providing appropriate pillows and turn-over tools, and creating indexes of monitoring the comfort level of lying on back, the comfort of the patients increased to 94.1%, reaching the objective of the project. The project provides a useful reference for improving the quality of clinical care.