A Clinical Study Of The Bed-ridden Time And Posture After Lumbar Puncture On Evidence-based Medicine

Part 1Objective:This study will conduct the Meta analysis on the effects of related complication through shrinking the bed time after lumbar puncture and changing the bed-rest posture to ensure the optimal bed time and posture.Methods: Through retrieval in PubMed,the Cochrane Library,EMbase,Web of Science,CBMdisc,CNKI,Wangfang Data,and other assistive tools,two researchers have extracted the data after evaluating literatures included and made Meta analysis with RevMan 5.3 and Stata/SE 12.0 by using Cochrane systematic evaluation method.Results:18 related literatures were included in this article.Comparing the absolute bedtime 0.5-2 h with pillow-free horizontal 4-6 h,The analysis of headache rate from Meta analysis shows that there is no significant difference for the subgroup.[OR=0.79,95%CI(0.51,1.23),P=0.30],group of strict bed rest for 0.5 h [OR=0.97,95%CI(0.54,1.75),P=0.91],group of strict bed rest for 1 h[OR=0.87,95%CI(0.46,1.62),P=0.65],group of strict bed rest for 2 h[OR=0.74,95%CI(0.36,1.52),P=0.41],the same conclusion.Subgroup analysis of headache posture[OR=0.77,95%CI(0.47,1.24),P=0.28] no significant difference,horizontal position [OR=0.71,95%CI(0.36,1.40),P=0.32],prone position with head low and feet high [OR=0.12,95%CI(0.00,18.89),P=0.41],low occiput position[OR=0.99,95%CI(0.59,1.65),P=0.96],the same conclusion,pillow-free prone position[OR=2.59,95%CI(0.51,13.11),P=0.25].Comparing the absolute bedtime for 0.5-2 h with pillow-free horizontal for 4-6 h,the subgroup analysis of headache rate from Meta analysis showed that the degree of comfort would raise[OR=7.52,95%CI(1.61,35.06),P=0.01].the difference was statistically significant,group of strict bed rest for 0.5 h [OR=7.21,95%CI(0.08,613.60),P=0.38],group of strict bed rest for 1 h [OR=1.03,95%CI(0.45,2.34),P=0.95],no significant difference,group of strict bed rest for 2h[OR=17.48,95%CI(8.89,34.40),P<0.001],the difference was statistically significant.Subgroup analysis of comfort position: [OR=7.46,95%CI(1.52,36.57),P=0.01],the difference was statistically significant.Horizontal position [OR=7.01,95%CI(0.08,623.53),P=0.40],prone position with head low and feet high [OR=1.03,95%CI(0.45,2.34),P=0.95],no significant difference,low occiput position.[OR=17.48,95%CI(8.89,34.40),P<0.001],the difference was statistically significant.Comparing pillow-free horizontal position for 0.5-2 h with pillow-free horizontal position for 4-6 h,incidence of back pain[OR=0.24,95%CI(0.04,1.63),P=0.14],no significant difference;incidence of pressure injury[OR=0.01,95%CI(0.00,0.03),P< 0.001],the difference was statistically significant.Conclusion: It will not increase the incidence of headache and low back pain to have strict bed rest in low occipital position for 2 h after lumbar puncture.However,it will probably reduce the incidence of pressure injury and increase the degree of comfort.Part 2Objective: The article would explore the possibility of optimizing the bed-ridden time and posture after lumbar puncture(low occiput for 2 hours)on evidence-based medicine.Methods: 184 patients,who had lumbar puncture in Hematology Department in the First Hospital of Lanzhou University from May 1st 2018 to October 31 st 2018,met the exclusion criteria and were selected as objects of study,and 92 of them were randomly grouped.After LP their heads should be kept as straight as the trunk with a5 cm soft pillow to avoid bending or lowering.Meanwhile they were required to get out of the bed after lying down for 2 hours instead of strenuous exercises.However,92 patients in control group were asked to lie down for 6 hours without strenuous exercises.Thus,the article would discuss the safety and feasibility of the two conditions mentioned above.Results: Baseline data were comparable between 2 hours after lumbar puncture and 6 hours after occipital supine position(P<0.05).There were no significant differences in heart rate,blood pressure(P>0.05).There was no statistical significance in the incidence of PLPH,PLPH pain score,nausea,vomiting,cervical rigidity or infection among complications.However,two hours of low occipital position can reduce the incidence and score of low back pain and stress injury(P<0.05).The analysis of influence factors of PLPH shows that age,gender and PLPH experience are related ones,among which gender is the most influential factor,followed by PLPH experience and age.Conclusion:Low occipital position for 2 hours has advantages in lessening back pain and stress injury instead of increasing the incidence of complications after LP,which is worthy to be popularized.