Department of Paediatrics and Child Health, Kocaeli University Faculty of Medicine, Umuttepe Yerleskesi, Izmit, Kocaeli, 41380, Turkey.
Arch Dis Child Fetal Neonatal Ed. 2013 Mar;98(2):F133-5. doi: 10.1136/archdischild-2011-301475. Epub 2012 Jun 9.
Realising the paucity of data in the standardisation of the optimal position for lumbar puncture (LP) in hospitalised neonates, we have designed an observational study to measure the interspinous distance in infants in a university hospital setting. The infants were placed in two lateral recumbent and two upright positions (lateral recumbent without flexing the hips, lateral recumbent with maximal hip flexion, sitting without flexing the hips and sitting with maximal hip flexion) with concomitant heart rate (HR), transcutaneous oxygen saturation (OS) and interspinous distance (with ultrasonography) measurements. Having the patient sit with maximal hip flexion provided the largest interspinous space for the grand majority of the infants. Sitting positions with/without flexion have resulted in significant increases in HR with respect to lateral recumbent position without flexion. Although statistically significant drops in OSs have been observed between lateral recumbent and sittting with flexion, lateral recumbent with flexion and sitting without flexion, and lateral recumbent with flexion and sitting with flexion positions; no adverse hypoxic events occurred during positioning. Sitting flexed position, which seems to be sufficiently safe and serve to enhance the success rate of a LP, should be favoured for sick neonates whenever the infant's condition permit a spinal tap.
鉴于在医院环境中对住院新生儿腰椎穿刺（LP）最佳位置的标准化方面数据的匮乏，我们设计了一项观察性研究，以测量在大学医院环境中婴儿的棘突间距离。将婴儿置于两种侧卧位和两种直立位（不弯曲髋关节的侧卧位、髋关节最大弯曲的侧卧位、不弯曲髋关节的坐姿和髋关节最大弯曲的坐姿），同时测量心率（HR）、经皮血氧饱和度（OS）和棘突间距离（超声检查）。让患者以最大髋关节弯曲的姿势坐立，为绝大多数婴儿提供了最大的棘突间空间。与不弯曲髋关节的侧卧位相比，髋关节弯曲的坐姿和不弯曲髋关节的坐姿均导致 HR 显著增加。尽管在侧卧位与髋关节弯曲的坐姿、髋关节弯曲的侧卧位与髋关节不弯曲的坐姿以及髋关节弯曲的坐姿与髋关节弯曲的坐姿之间观察到 OS 有统计学显著下降，但在定位过程中没有发生缺氧不良事件。对于病情允许进行脊髓穿刺的患病新生儿，应优先考虑弯曲坐姿，因为这种坐姿似乎足够安全，并有助于提高 LP 的成功率。
