소아혈액 종양환자의 요추천자 후 침상안정시간이 천자 후 두통에 미치는 영향

The Effect of the Periods of Bed Rest on the Postlumbar Puncture Headache in Pediatric Oncology Patients

Bed rest is recommended to prevent postlumbar puncture headaches(PLPHA), but the period of bed rest varies in the literature from 6 hours to 24 hours. In clinical practice the period of bed rest varies but nursing methods for adults and children have little difference. In Seoul National University Hospital, children have been given at least 6 hours bed rest after a lumbar puncture. Pediatric oncology patients require a lumbar puncture for an initial diagnosis, follow up treatment or administration of chemotherapeutic agent. But it is difficult for young children to lie supine or to refrain from their usual activities in any way, and unpleasant problems related to a shortage of beds often occurs during discharge or in an outpatient setting. The purpose of this study is to substantiate the preventive effect of PLPHA by the period of bed rest, to identify the other factors that influence PLPHA, and to use the nursing methods proper to children. The subjects were 65 children, ages 1-17, undergoing treatment in the children's cancer center at SNUCH during the period June 1, 1995, to Aug. 31, 1995. The team nurses asked questions about PLPHA of the parents and children in order to fill out a questionnaire. The data were evaluated by percent, t-test, Chi-square test and Mann-Whitney U test. Result; 1. There was no significant difference relating the bed rest time spent to the occurrence of postspinal headaches (t-test). 2. There was a significant risk of PLPHA in the children who were irritable before procedure and/or had experienced previous PLPHA(p<0.05, ${x^2}-test$). 3. The following factors were not found to be associated with increased risk of PLPHA: previous puncture experience, giving analgesics, the choice of puncturist, inpatient/outpatient status, gauge of needle, purpose, the amount of CSF removed, gender, diagnosis, the number of peripheral WBCs, previous lumbago experience after LP, position after bed rest, age, the number of aural puncture at the time. A longer period of bed rest is unlikely to be more effective to prevent PLPHA and seems impractical. A shorter period will save time and effort. Perhaps it will also allay some of the fears which surround LP. So 1 hour bed rest after LP is suggested and nursing methods for emotional support should be investigated to reduce PLPH.