Factors associated with the onset and persistence of post-lumbar puncture headache.
Factors associated with the onset and persistence of post-lumbar puncture headache.
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DOI：
10.1001/jamaneurol.2014.3974
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发表时间：
2015-03
期刊：
影响因子：
29
通讯作者：
Bateman, Randall J.
中科院分区：
文献类型：
--
作者：
Monserrate, Andres E.;Ryman, Davis C.;Ma, Shengmei;Xiong, Chengjie;Noble, James M.;Ringman, John M.;Morris, John C.;Danek, Adrian;Mueller-Sarnowski, Felix;Clifford, David B.;McDade, Eric M.;Brooks, William S.;Darby, David G.;Masters, Colin L.;Weston, Philip S. J.;Farlow, Martin R.;Graff-Radford, Neill R.;Salloway, Stephen P.;Fagan, Anne M.;Oliver, Angela;Bateman, Randall J.
本研究评估了与腰椎穿刺后最常见不良事件相关的因素。确定与硬膜穿刺后头痛（PDPH）的风险、发作和持续性相关的因素。我们使用线性混合模型对显性遗传阿尔茨海默病网络观察性研究中的338例腰椎穿刺进行了单变量和多变量分析，并对参与者水平和家庭水平的随机效应进行了调整。我们直接评估了3种腰椎穿刺后结局（术后即刻头痛、24小时随访时的PDPH和接受治疗性血液贴片的PDPH）与参与者年龄和性别、体位、采集方法、针头尺寸、针头插入部位和采集的脑脊液（CSF）量的相关性。不良事件的发生率包括73例术后即刻头痛（21.6%），59例PDPH在24小时随访时（17.5%），15例PDPH接受治疗性血液贴片（4.4%）。收集的脑脊液体积越大，术后即刻头痛的风险越高，这主要是由于收集的脑脊液体积超过30 mL时风险呈非线性增加（比值比，>30 mL为3.73，<17 mL为0.98）。相比之下，收集更高的体积显示出保护作用，降低了24小时随访时的PDPH发生率和接受治疗性血液贴片的PDPH发生率（比值比，0.35/10 mL）。尽管针头尺寸的差异没有达到统计学显著性，但24 G针头组中没有参与者接受治疗性血液贴片，而22 G针头组中有8/253人接受治疗性血液贴片。急性降低CSF压力的因素（例如，坐位或抽取大量CSF）可能与腰椎穿刺后一过性头痛相关，而不会增加持续性PDPH或治疗性血斑的发生率。收集高达30 mL的CSF似乎耐受性良好且安全。
This study assesses factors associated with the most common adverse event following lumbar puncture. To identify factors associated with the risk, onset, and persistence of post–dural puncture headache (PDPH). We performed univariate and multivariable analyses of 338 lumbar punctures in the Dominantly Inherited Alzheimer Network observational study using linear mixed models, adjusting for participant-level and family-level random effects. We directly evaluated associations of 3 post–lumbar puncture outcomes (immediate postprocedural headache, PDPH at 24-hour follow-up, and PDPH receiving a therapeutic blood patch) with participant age and sex, positioning, collection method, needle size, needle insertion site, and cerebrospinal fluid (CSF) volume collected. The incidence of adverse events included 73 immediate postprocedural headaches (21.6%), 59 PDPHs at 24-hour follow-up (17.5%), and 15 PDPHs receiving a therapeutic blood patch (4.4%). Greater volume of CSF collected was associated with increased risk of immediate postprocedural headache, largely owing to a nonlinear increase in risk on collection of volumes above 30 mL (odds ratio, 3.73 for >30 mL and 0.98 for <17 mL). In contrast, collection of higher volumes showed a protective effect in decreasing rates of PDPH at 24-hour follow-up and rates of PDPH receiving a therapeutic blood patch (odds ratio, 0.35 per 10 mL). Although differences in needle size did not reach statistical significance, no participant in the 24G needle group received a therapeutic blood patch compared to 8 of 253 for the larger 22G needles. Factors that acutely lower CSF pressure (eg, seated positioning or extracting very high volumes of CSF) may be associated with transient post-lumbar puncture headache, without increasing rates of persistent PDPH or therapeutic blood patch. Collection of up to 30 mL of CSF appears to be well tolerated and safe.
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