Abbrescia K L, Brabson T A, Dalsey W C, Kelly J J, Kaplan J L, Young T M, Jenkins D, Chu J, Emery M S
Department of Emergency Medicine, Albert Einstein Medical Center, Philadelphia, PA 19141, USA.
Acad Emerg Med. 2001 Jan;8(1):8-12. doi: 10.1111/j.1553-2712.2001.tb00538.x.
To determine the effects of lower-extremity positioning on cerebrospinal fluid opening pressure (CSFp). The authors believed that during lumbar puncture (LP), CSFp does not meaningfully decrease when the lower extremities are extended from flexion, as is often suggested.
In a convenience sample of adult patients who clinically required LP in an urban emergency department, three sequential CSFp measurements were obtained in either sequence A (knee, hip, and neck flexion [90 degrees ], then extension, then flexion) or sequence B (extension, flexion, then extension) prior to CSF withdrawal. The neck was flexed at 30 degrees when the lower extremities were flexed, while the thoracolumbar spine was kept in the neutral position for all measurements.
Nineteen patients were studied in each sequence. Although variable, overall within-patient changes between positions were not clinically meaningful. Mean and 95% confidence intervals (95% CIs) for the decrease in CSFp from position 1 to position 3 (same position) were 0.2 cm H(2)O (1.7%) and 0.9 to -0.6 cm H(2)O (6% to -2.7%), respectively. Changing from flexion to extension decreased pressure measurements by a mean of 0.9 cm H(2)O (2.5%) [95% CI = 2.1 to -0.1 cm H(2)O (7.6% to -2.4%)]. Changing from extension to flexion increased CSFp by a mean of 1.1 cm H(2)O (6.1%) [95% CI = 0.2 to 2.0 cm H(2)O (1.3% to 11.5%)], a statistically but not clinically meaningful change.
Changing lower-extremity position did not meaningfully change mean CSFp. These data do not support the common suggestion that extending the lower extremities during LP meaningfully decreases CSF opening pressures.
确定下肢位置对脑脊液初压（CSFp）的影响。作者认为，在腰椎穿刺（LP）过程中，下肢从屈曲位伸展时，脑脊液初压并不会像通常所认为的那样显著降低。
在城市急诊科临床需要进行腰椎穿刺的成年患者便利样本中，在抽取脑脊液之前，按照序列A（膝关节、髋关节和颈部屈曲[90度]，然后伸展，然后再屈曲）或序列B（伸展、屈曲，然后再伸展）依次进行三次脑脊液初压测量。当下肢屈曲时，颈部屈曲30度，而在所有测量过程中胸腰椎保持在中立位。
每个序列研究了19例患者。尽管存在个体差异，但各位置间患者总体的变化在临床上并无显著意义。从位置1到位置3（同一位置）脑脊液初压降低的平均值及95%置信区间（95%CI）分别为0.2 cmH₂O（1.7%）和0.9至 -0.6 cmH₂O（6%至 -2.7%）。从屈曲变为伸展时，压力测量值平均降低0.9 cmH₂O（2.5%）[95%CI = 2.1至 -0.该文档为腰椎穿刺时下肢位置对脑脊液初压影响的研究，通过对成年患者不同下肢位置序列进行脑脊液初压测量，发现下肢位置改变对脑脊液初压平均值无显著影响，不支持腰椎穿刺时伸展下肢会显著降低脑脊液初压的常见观点。1 cmH₂O（7.6%至 -2.4%）]。从伸展变为屈曲时，脑脊液初压平均升高1.1 cmH₂O（6.1%）[95%CI = 0.2至2.0 cmH₂O（1.3%至11.5%）]，这是一个有统计学意义但无临床意义的变化。
改变下肢位置并不会显著改变脑脊液初压平均值。这些数据不支持腰椎穿刺时伸展下肢会显著降低脑脊液初压的常见观点。
