Avery Robert A, Mistry Rakesh D, Shah Samir S, Boswinkel Jan, Huh Jimmy W, Ruppe Michael D, Borasino Santiago, Licht Daniel J, Seiden Jeffrey A, Liu Grant T
Division of Neurology, Children's Hospital of Philadelphia, Pennsylvania 19104-4399, USA.
J Child Neurol. 2010 May;25(5):616-9. doi: 10.1177/0883073809359198. Epub 2010 Feb 22.
The recommendation to measure cerebrospinal fluid opening pressure in the extended, rather than the flexed lateral recumbent position to avoid false elevation of the opening pressure has not been formally evaluated in children. This single-center prospective cohort study includes 53 children who had their opening pressure measured in both the flexed and extended lateral recumbent positions prior to removing any cerebrospinal fluid (mean age = 11.7 years; 60% male). The mean opening pressure was higher in the flexed (25.1 +/- 9.2 cm H2O) compared with the extended (24.4 +/- 8.4 cm H2O) position (mean difference = 0.6 +/- 2.2 cm H2O; Z = 2.021, P < .03). Most (92.4%) opening pressure measurements had less than a 5 cm H2O difference between positions. Lumbar puncture performed in the extended, rather than the flexed lateral recumbent position results in a statistically significant decrease in cerebrospinal fluid opening pressure, although the magnitude of the difference is small and of doubtful clinical significance.
为避免脑脊液初压假性升高，建议在伸展位而非屈曲侧卧位测量脑脊液初压，但这一建议尚未在儿童中得到正式评估。这项单中心前瞻性队列研究纳入了53名儿童，他们在抽取任何脑脊液之前，分别在屈曲侧卧位和伸展侧卧位测量了初压（平均年龄 = 11.7岁；60%为男性）。与伸展位（24.4±8.4 cm H₂O）相比，屈曲位（25.1±9.2 cm H₂O）的平均初压更高（平均差值 = 0.6±2.2 cm H₂O；Z = 2.021，P < 0.03）。大多数（92.4%）初压测量值在不同体位之间的差异小于5 cm H₂O。在伸展侧卧位而非屈曲侧卧位进行腰椎穿刺，脑脊液初压会出现具有统计学意义的下降，尽管差异幅度较小且临床意义存疑。
