Ditta M, Galea J, Holland J, Patel H C
University of Manchester, School of Medicine, Oxford Road, Manchester, UK.
Br J Neurosurg. 2013 Oct;27(5):599-602. doi: 10.3109/02688697.2013.771137. Epub 2013 Feb 28.
Because of potential risks of poor outcome, lumbar puncture (LP) is recommended to exclude the presence of blood breakdown products in patients with suspected subarachnoid haemorrhage (SAH) and a normal CT scan. The aim of this study was to document how often this test proved useful.
A retrospective analysis of prospectively recorded data was conducted. Patients with suspected SAH and a normal CT scan in whom LP was recommended between May 2008 and May 2010 were identified using the neurosurgical referral database. CT scan results, LP results, inpatient stay, investigations and interventions were recorded.
One hundred and sixty-three patients were identified in whom LP was recommended after a reported negative CT scan. Thirty-six of these 163 patients had a positive LP of which seven had evidence of SAH on the initial CT scan. In 66 patients, the LP was not diagnostic and 59/66 (90%) patients underwent secondary imaging in whom five with aneurysms were identified and treated.
LP-driven decision making in patients with a normal scan and suspected SAH is suboptimal in over a third of cases. Patients with a non-diagnostic LP harboured five aneurysms that merited treatment. These results support the need for secondary investigations following suspected SAH, but suggest that these could take the form of secondary imaging rather than a lumbar puncture.
鉴于预后不良的潜在风险，对于疑似蛛网膜下腔出血（SAH）且CT扫描正常的患者，建议进行腰椎穿刺（LP）以排除血液分解产物的存在。本研究的目的是记录该检查证明有用的频率。
对前瞻性记录的数据进行回顾性分析。使用神经外科转诊数据库识别出2008年5月至2010年5月期间推荐进行LP检查的疑似SAH且CT扫描正常的患者。记录CT扫描结果、LP结果、住院时间、检查和干预措施。
确定了163例在报告CT扫描阴性后推荐进行LP检查的患者。这163例患者中有36例LP结果为阳性，其中7例在初始CT扫描时有SAH证据。在66例患者中，LP检查未得出诊断结果，66例中的59例（90%）患者接受了二次影像学检查，其中5例发现动脉瘤并接受了治疗。
对于扫描正常且疑似SAH的患者，由LP检查驱动的决策在超过三分之一的病例中并非最佳选择。LP检查未得出诊断结果的患者中有5例动脉瘤值得治疗。这些结果支持在疑似SAH后需要进行二次检查，但表明这些检查可以采取二次影像学检查的形式，而不是腰椎穿刺。
