Cerebrospinal fluid test - chemical test - protein test

Cerebrospinal fluid examination - chemical examination - protein examination is the determination of protein content in cerebrospinal fluid. The protein content of cerebrospinal fluid is closely related to the blood-brain barrier and can reflect the signs of various diseases. The protein content of cerebrospinal fluid increases with age. In neonates, due to the imperfect development of the blood-brain barrier, the protein in cerebrospinal fluid is relatively high, and gradually declines to adult levels after 6 months. The protein content of cerebrospinal fluid is found in: blood barrier permeability-enhancing diseases. Basic Information Specialist classification: growth and development check classification: cerebrospinal fluid examination Applicable gender: whether men and women apply fasting: fasting Analysis results: Below normal: May be malnourished. Normal value: Adult: 150-450mg/L Children: 200-400mg/L Above normal: Common in chronic infection with demyelinating polyneuropathy. negative: Positive: Tips: Patients with shock, exhaustion or endangered status and local skin inflammation, and lesions in the posterior cranial fossa are classified as contraindications. Normal value Children: 200 ~ 400mg / L. Adult: 150 ~ 450mg / L. Clinical significance Abnormal result 1. The protein content of cerebrospinal fluid is increased and the number of cells is not high, which is a phenomenon of cell-protein separation. The degree of protein increase is usually different, usually 1 to 5 g/L. Generally, the protein starts to rise at the end of the week after the onset of symptoms. At the third week, the protein content is the highest, and then gradually decreases. It may be acute infectious polyneuritis. 2, protein increased, protein content is often in the range of 0.8 ~ 2.5g / L, and some as high as 9.5g / L, is a chronic infection of demyelinating polyneuropathy. 3. The protein content in cerebrospinal fluid is normal or slightly elevated, 38.8% below 0.4g/L, 45.7% in 0.4-1.0g/L, 15.5% above 1.0g/L, and the highest is 4.8g/L. Myelitis. 4, the protein increased slightly in the early stage, increased to 1.0 ~ 1.5g / L after 1 week, and gradually returned to normal after 3 to 4 weeks. May have acute spinal anterior polio. 5, protein quantification per liter to 10 grams, placed aside to self-coagulation, said self-condensation phenomenon. Generally, the more complete the blockage, the longer the blockage time, and the lower the blockage level, the higher the protein content. The tumor has a high content of protein, especially schwannomas, which has a higher protein content than other tumors. It is spinal cord compression. 6. The cerebrospinal fluid is transparent or frosted, and the white fiber membrane is formed after the specimen is placed for several hours. The protein content is moderately elevated, about 1 to 2 g/L, and up to 5.0 g/L, which can confirm tuberculous meningitis. 7, the number of cells is normal and the protein content is higher than the intraventricular or brain manifestations of tumors and schwannomas. 8, high protein content, this situation can still be seen 2 to 3 weeks after bleeding, is for subarachnoid hemorrhage. 9. Normal or slightly elevated protein content is acute disseminated encephalomyelitis. If there is a significant increase, and no spinal canal obstruction, it suggests that the nerve root is involved. The people who need to be examined are people with heart palpitations, fatigue, sweating, hunger, paleness, tremors, nausea and vomiting. High results may be diseases: lymphocytic choroid plexus meningitis, normal pressure hydrocephalus in the elderly, encephalopathy precautions Contraindications before examination: Cerebrospinal fluid should be taken on an empty stomach. Requirements for inspection: Children may be afraid of the inspection when they are inspected, and they need to be comforted and guided in time. If the patient has symptoms such as breathing, pulse, or abnormal color during puncture, stop the operation immediately and deal with it accordingly. Inspection process 1. The patient lies on the hard board bed, the back is perpendicular to the table top, the head is bent as far as possible to the chest, the knees are tightly attached to the abdomen with both hands, so that the trunk is as arched as possible; or the assistant is used to hold the patient's head opposite the surgeon. The other hand pulls the lower limbs of the armpits and holds them tightly, so that the spine is as convex as possible to widen the intervertebral space, which is convenient for needle insertion. 2, determine the puncture point, usually the junction point of the highest point of the bilateral iliac spine and the posterior median line as the puncture point, here is equivalent to the third to fourth lumbar spine process, sometimes in the upper or lower lumbar spine The gap is carried out. 3, routine disinfection of the skin after wearing sterile gloves, cover the hole towel, with 2% lidocaine from the skin to the interspinous ligament for layer-by-layer local anesthesia. 4, the surgeon uses the left hand to fix the puncture point skin, the right hand holding puncture needle to the vertical back, the needle tip slightly obliquely to the direction of the head, the adult needle depth is about 4 ~ 6cm, children about 2 ~ 4cm. When the needle passes through the ligament and the dura mater, there is a sudden loss of resistance. At this point, the needle core can be slowly withdrawn (to prevent the cerebrospinal fluid from flowing out quickly, causing cerebral palsy), and the cerebrospinal fluid can be seen to flow out. 5. Connect the pressure measuring tube to measure the pressure before draining. The cerebrospinal fluid pressure in the normal lateral position is 70-180 mmH2O (0.098 Kpa=10 mmH2O) or 40-50 d/min. If you continue to do the queckstedt test, you can see if there is any obstruction in the subarachnoid space. That is, after the initial pressure is measured, the assistant first compresses one side of the carotid artery for about 10 s, then presses the other side, and finally presses both sides of the carotid artery. When the carotid artery is compressed at normal time, the pressure of the cerebrospinal fluid immediately increases by about one time, and after 10 to 20 seconds after the pressure is released, it rapidly drops to the original level, which is called negative in the obstruction test, indicating that the subarachnoid space is unobstructed; if the carotid artery is compressed, it cannot be When the pressure of the cerebrospinal fluid is raised, the obstruction test is positive, indicating that the subarachnoid space is completely blocked. If it rises slowly after applying pressure, it will slowly fall after relaxation, indicating incomplete obstruction. but. Those with increased intracranial pressure are forbidden to do this test. 6. Remove the pressure measuring tube and collect 2~5ml of cerebrospinal fluid for examination. If it is needed for cultivation, use sterile tube to keep the specimen. 7. After the operation, insert the needle core and pull out the puncture needle together, cover the sterile gauze, and fix it with tape. 8, go to the pillow for 4 to 6 hours, so as not to cause postoperative low intracranial pressure headache. Not suitable for the crowd Patients with shock, exhaustion or endangerment and local skin inflammation, and lesions in the posterior cranial fossa are classified as contraindications. Adverse reactions and risks 1, subcutaneous hemorrhage: due to pressing time less than 5 minutes or blood draw technology is not enough, etc. can cause subcutaneous bleeding. 2, discomfort: the puncture site may appear pain, swelling, tenderness, subcutaneous ecchymosis visible to the naked eye. 3, dizzy or fainting: in the blood draw, due to emotional overstress, fear, reflex caused by vagus nerve excitement, blood pressure decreased, etc. caused by insufficient blood supply to the brain caused by fainting or dizziness. 4. Risk of infection: If you use an unclean needle, you may be at risk of infection.