Comparison of cutting and pencil-point spinal needle in spinal anesthesia regarding postdural puncture headache: A meta-analysis.
Comparison of cutting and pencil-point spinal needle in spinal anesthesia regarding postdural puncture headache: A meta-analysis.
复制标题
切割椎管针与笔尖椎管针椎管内麻醉治疗硬膜穿刺后头痛的比较荟萃分析
DOI：
10.1097/md.0000000000006527
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发表时间：
2017-04
期刊：
影响因子：
1.6
通讯作者：
Feng S
中科院分区：
文献类型：
--
作者：
Xu H;Liu Y;Song W;Kan S;Liu F;Zhang D;Ning G;Feng S
硬脊膜穿刺后头痛（PDPH）主要由脑脊液（CSF）丢失引起，是脊髓麻醉和诊断性腰椎穿刺的常见医源性并发症。脊椎穿刺针已经过改良，以尽量减少并发症。可改变的PDPH危险因素主要包括针头大小和针头形状。然而，对于PDPH的发生率是否在切尖针和尖针之间有显著差异存在争议。然后进行Meta分析，比较切割型和尖头型两种穿刺针的PDPH发生率。我们纳入了所有随机设计的试验，评估了接受选择性脊髓麻醉或诊断性腰椎穿刺的患者的临床结局，这些患者使用切割或双尖脊椎穿刺针作为合格研究。由2名研究者对所有入选研究及其偏倚风险进行评估。临床结局包括成功率、PDPH频率、报告的重度PDPH和硬膜外血液补片（EBP）的使用被记录为主要结果。使用风险比（RR）和二分变量的95%置信区间（CI）评价结果。使用Rev Man软件（版本5.3）分析所有适当数据。本研究纳入了25项随机对照试验（RCT）。分析结果显示，使用针尖式脊椎穿刺针可降低PDPH的发生率（RR 2.50; 95% CI [1.96，3.19]; P <0.00001）和重度PDPH的发生率（RR 3.27; 95% CI [2.15，4.96]; P <0.00001）。 针刺组EBP的使用率更低（RR 3.69; 95% CI [1.96，6.95]; P <0.0001）。 目前的证据表明，在PDPH的发生率、PDPH的严重程度和EBP的使用方面，与切割式脊椎穿刺针相比，针尖式脊椎穿刺针具有明显的上级优势。鉴于此，我们建议在腰麻和腰穿中使用腰骶针。
Postdural puncture headache (PDPH), mainly resulting from the loss of cerebral spinal fluid (CSF), is a well-known iatrogenic complication of spinal anesthesia and diagnostic lumbar puncture. Spinal needles have been modified to minimize complications. Modifiable risk factors of PDPH mainly included needle size and needle shape. However, whether the incidence of PDPH is significantly different between cutting-point and pencil-point needles was controversial. Then we did a meta-analysis to assess the incidence of PDPH of cutting spinal needle and pencil-point spinal needle. We included all randomly designed trials, assessing the clinical outcomes in patients given elective spinal anesthesia or diagnostic lumbar puncture with either cutting or pencil-point spinal needle as eligible studies. All selected studies and the risk of bias of them were assessed by 2 investigators. Clinical outcomes including success rates, frequency of PDPH, reported severe PDPH, and the use of epidural blood patch (EBP) were recorded as primary results. Results were evaluated using risk ratio (RR) with 95% confidence interval (CI) for dichotomous variables. Rev Man software (version 5.3) was used to analyze all appropriate data. Twenty-five randomized controlled trials (RCTs) were included in our study. The analysis result revealed that pencil-point spinal needle would result in lower rate of PDPH (RR 2.50; 95% CI [1.96, 3.19]; P < 0.00001) and severe PDPH (RR 3.27; 95% CI [2.15, 4.96]; P < 0.00001). Furthermore, EBP was less used in pencil-point spine needle group (RR 3.69; 95% CI [1.96, 6.95]; P < 0.0001). Current evidences suggest that pencil-point spinal needle was significantly superior compared with cutting spinal needle regarding the frequency of PDPH, PDPH severity, and the use of EBP. In view of this, we recommend the use of pencil-point spinal needle in spinal anesthesia and lumbar puncture.