Whitelaw A
Child Health, University of Bristol, Southmead Hospital, Bristol, UK, BS10 5NB.
Cochrane Database Syst Rev. 2000(2):CD000216. doi: 10.1002/14651858.CD000216.
This section is under preparation and will be included in the next issue.
To determine whether repeated CSF tapping, by lumbar puncture or ventricular tap, reduced the risk of permanent shunt dependence, neurodevelopmental disability or death in neonates at risk of, or actually developing, post-hemorrhagic hydrocephalus (PHH). This form of treatment was based on the hypothesis that repeated tapping removed protein and blood from the CSF, thus clearing obstruction from the channels of CSF absorption.
Pediatric, Neurosurgical and General Medical Journals were handsearched from 1976, as well as the Medline database. Personal contacts were used.
Four controlled trials ( with five published papers) were identified, three being randomised and the fourth using alternative allocation. Two trials evaluated repeated lumbar punctures in neonates with intraventricular hemorrhage (IVH) and two trials evaluated repeated CSF tapping infants with IVH followed by progressive ventricular dilatation.
In addition to details of the patient selection and patient allocation, the interventions were extracted. The end-points examined were: ventriculoperitoneal shunt, death, disability, multiple disability and death or disability.
The studies were sufficiently similar in the question they were asking and the interventions were sufficiently in common that they could be combined when assessing the effect of the intervention. When repeated CSF tapping was compared to conservative treatment, the relative risks for shunt placement, death, disability and multiple disability were very close to 1.0 with no statistically significant effect. There is also evidence that this form of treatment increased the risk of CSF infection.
REVIEWER'S CONCLUSIONS: Early repeated CSF tapping cannot be recommended for neonates at risk of, or actually developing, post-hemorrhagic hydrocephalus.
本节正在编写中，将在下一期发表。
确定通过腰椎穿刺或脑室穿刺反复进行脑脊液引流，是否能降低有出血后脑积水（PHH）风险或已实际发生PHH的新生儿永久性依赖分流、神经发育障碍或死亡的风险。这种治疗方式基于这样的假设，即反复引流可清除脑脊液中的蛋白质和血液，从而解除脑脊液吸收通道的梗阻。
对1976年以来的儿科、神经外科和普通医学期刊以及Medline数据库进行了手工检索，并通过个人联系获取信息。
共确定了四项对照试验（发表了五篇论文），其中三项为随机试验，第四项采用交替分配。两项试验评估了对脑室出血（IVH）新生儿进行反复腰椎穿刺的效果，两项试验评估了对IVH后出现进行性脑室扩张的婴儿进行反复脑脊液引流的效果。
除了患者选择和分配的详细信息外，还提取了干预措施。所检查的终点指标包括：脑室腹腔分流、死亡、残疾、多重残疾以及死亡或残疾。
这些研究在研究问题上足够相似，干预措施也足够一致，因此在评估干预效果时可以合并分析。将反复脑脊液引流与保守治疗进行比较时，分流置入、死亡、残疾和多重残疾的相对风险非常接近1.0，无统计学显著差异。也有证据表明这种治疗方式会增加脑脊液感染的风险。
对于有出血后脑积水风险或已实际发生出血后脑积水的新生儿，不建议早期反复进行脑脊液引流。
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