Needle type and the risk of post-lumbar puncture headache in the outpatient neurology clinic
Needle type and the risk of post-lumbar puncture headache in the outpatient neurology clinic
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DOI：
10.1016/j.jns.2011.04.004
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发表时间：
2011-07-15
影响因子：
4.4
通讯作者：
Levy, Michael
中科院分区：
文献类型：
--
作者：
Hammond, Edward R.;Wang, Zhuangjun;Levy, Michael
目的：腰椎穿刺后头痛（PLPH）是诊断性腰椎穿刺（LP）的常见并发症，由硬脊膜穿刺部位持续性脑脊液泄漏引起。我们进行了一项前瞻性研究，以确定与PLPHs在神经科门诊setting.Methods相关的危险因素：从所有诊断LP在约翰霍普金斯腰椎穿刺诊所2008年9月和2009年6月之间进行的临床信息进行了审查。作为标准治疗，主治医生在LP后2-5天内通过电话联系每例患者，以确定健康状况和PLPH的存在。我们进行了多元逻辑回归分析，以评估PLPH和针头类型之间的关联（传统Quincke切割针20和22号，20 Q和22 Q和Sprotte非创伤性规格22针，22 S）调整重要变量，如创伤性LP、尝试次数、定位和抽取的CSF体积。使用常用规格的20 Q和22 Q缝针的PLPH患病率为32%，而使用22 S无创缝针的患病率为19%。与20 Q穿刺针相比，非创伤性22 S穿刺针与PLPH几率降低69%相关（调整后OR：031，95%CI 0.12-0.82）。在亚组分析中，与22 S针相比，使用22 Q针时PLPH的几率增加了4倍（调整后OR = 3.99，95%CI 132-12.0）。结论：我们的门诊研究结果支持美国神经病学学会的建议，即使用较小的非创伤性针来降低PLPH的风险。(C)2011爱思唯尔有限公司版权所有。
Objective: Post-lumbar puncture headaches (PLPHs) are a common complication of diagnostic lumbar punctures (LPs) caused by a persistent leak of spinal fluid from the dural puncture site. We conducted a prospective study to determine risk factors associated with PLPHs in the neurology outpatient setting.Methods: Clinical information from all diagnostic LPs performed at the Johns Hopkins Lumbar Puncture Clinic between September 2008 and June 2009 was reviewed. As standard of care, each patient was contacted by telephone by the attending physician within 2-5 days of having an LP to ascertain health status and the presence of PLPH. We performed multiple logistic regression analysis to evaluate the association between PLPH and needle type (traditional Quincke cutting needle 20 and 22 gauge, 20Q and 22Q and Sprotte non-traumatic gauge 22 needle, 22S) adjusting for important variables such as traumatic LPs, number of attempts, positioning and volume of CSF drawn.Results: The prevalence of PLPH was 32% with the popular gauge 20Q and 22Q needles compared to 19% with the 22S non-traumatic needle. Compared to the 20Q needle, the non-traumatic 22S needle was associated with 69% decreased odds of PLPH (adjusted OR: 031,95% CI 0.12-0.82). In subset analysis, the odds of PLPH increased 4-fold when the 22Q needle was used compared to the 22S needle (adjusted OR = 3.99, 95% CI 132-12.0).Conclusions: Our outpatient findings support the American Academy of Neurology recommendations to use smaller non-traumatic needles to reduce the risk of PLPH. (C) 2011 Elsevier B.V. All rights reserved.