腰肌勞損外科護理學(xué)

1、慢性軟組織損傷之 腰肌勞損 strain of the lumbar muscles,主講人：夏婼,概念,又稱功能性腰痛、腰背肌筋膜炎主要指腰背部肌肉、筋膜、韌帶等軟組織的慢性、疲勞性損傷，導(dǎo)致局部無菌性炎癥，引起腰背部一側(cè)或兩側(cè)的彌漫性疼痛的一種病癥。 為腰痛常見的原因,病因,長期過度負重脊柱結(jié)構(gòu)失穩(wěn)長期彎腰工作其他,病理生理,肌肉、筋膜及韌帶持續(xù)受到牽拉時，肌肉內(nèi)的壓力增加，血供

2、受阻，肌纖維在收縮時消耗的能源得不到補充，產(chǎn)生大量乳酸，加之代謝產(chǎn)物不能得到及時清除，積聚過多而引起炎癥、粘連，如此反復(fù)可導(dǎo)致組織變性、增厚及痙攣，并刺激相應(yīng)的神經(jīng)引起慢性腰痛,臨床表現(xiàn),癥狀無明顯誘因的慢性腰部或腰骶部疼痛，反復(fù)發(fā)作，疼痛隨氣候變化或勞累程度而變化，時輕時重，遷延不愈呈鈍性脹痛或酸痛不適，休息、適當活動或經(jīng)常改變體位姿勢可使癥狀減輕。腰部喜熱怕冷，局部皮膚感覺遲鈍或粗糙感。腰部活動：有時在活動時有牽掣不適感。

3、不耐久坐久站，不能勝任彎腰工作，彎腰稍久，便直腰困難急性發(fā)作時，可有明顯的肌痙攣，甚至出現(xiàn)腰脊柱側(cè)彎，下肢牽擎作痛等癥狀。,體征 壓痛：腰背部固定壓痛點，多在骶髂關(guān)節(jié)背面、骶骨背面和腰椎橫突等處。輕者壓痛多不明顯。常被迫伸腰雙手捶擊或叉腰等動作，以減輕疼痛，這是與深部骨骼疾患的區(qū)別之一 放射痛：不同壓痛點產(chǎn)生不同部位放射痛，臨床常據(jù)此對腰部損傷與椎間盤突出癥進行鑒別診斷 骶棘肌痙攣征 ：為腰部勞

4、損所致，有單側(cè)或雙側(cè)骶棘肌痙攣征，肌收縮隆起，由于患側(cè)腰肌收縮，骨盆傾斜，腰部顯得板硬，起臥床較費力,輔助檢查,X線檢查多無異常，少數(shù)可有骨質(zhì)增生或脊柱畸形；年老或骨質(zhì)疏松病人，可選擇ECT檢查或骨密度檢查,nursing diagnosis,Pain related to tissue chronic injuryThe lack of knowledge related to lack of functional exer

5、cise and disease preventionAnxiety related to recurrent episodes of disease,principle of management,To eliminate the cause:Improve your position, posture, and avoid bending over longUse the waistline, take it off wh

6、en rest, lest the secondary apraxia of muscle atrophyAlways move the waist and avoid prolonged periods in the same position,Avoid damp, coldSleep hard bedMake the waist posture compatible with biomechanicsWhen the di

7、sease is heavier, bed rest is appropriate and the bed position is often changed,Comprehensive treatment:,Physical therapy: waxing, electrotherapy, Medical massage, acupuncture cuppingDrug therapy: The pain point is fe

8、asible for adrenal corticosteroid injection. When the pain in the waist is obvious, you can take NSAID to relieve muscle pain, but not long-term,Functional exercise,Quadriceps muscle contraction practice: 5-10 minute

9、s each time, 3-4 times a dayBack muscle practice: The flying swallow is supported by five-point,, 1-2 weeks and then the 3-point support method, 3-4 times a day, 50 times each time,Nursing measures,Relieves pain: Cr

10、eate a quiet, comfortable hospital environment, distract the attention of patient and guide it. When the pain is apparent, you can take NSAID to relieve muscle pain.Psychological care,Health guide:Explain the etiology

11、, pathology, treatment and prevention of diseases, rehabilitation training methods and precautionsThe waistline method and the use timeKeep proper posture in your daily work life, keep warm and avoid the cause of the d