Department of Emergency Medicine, Harbor-UCLA Medical Center, Los Angeles, CA; Los Angeles Biomedical Research Institute, Los Angeles, CA; Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Acad Emerg Med. 2014 Feb;21(2):130-6. doi: 10.1111/acem.12305.
The objective was to determine if use of ultrasound (US) by emergency physicians (EPs) to localize spinal landmarks improves the performance of lumbar puncture (LP).
This was a prospective, randomized, controlled study conducted in a county teaching hospital. Subjects, adults 18 years of age or older who were to receive LPs for routine clinical care in the emergency department (ED), were randomized either to undergo US localization of the puncture site or to have the puncture site determined by palpation of spinal landmarks. Primary outcomes were the number of needle insertion attempts and success of the procedure. Secondary outcomes were pain associated with the procedure, time to perform the procedure, number of traumatic taps, and patient satisfaction with the procedure.
One-hundred patients were enrolled in the study, with 50 in each study group. There were no significant differences between the two groups in terms of age, sex, body mass index (BMI), indication for LP, or ease of palpation of landmarks. For both primary outcomes and secondary outcomes there were no significant differences between those undergoing US localization and those with palpation alone.
These data do not suggest any advantage to the routine use of US localization for LP insertion, although further study may be warranted to look for benefit in the difficult to palpate or obese patient subgroups.
本研究旨在确定急诊医师（EP）使用超声（US）定位脊柱标志是否能提高腰椎穿刺（LP）的成功率。
这是一项在县级教学医院进行的前瞻性、随机、对照研究。研究对象为年龄在 18 岁或以上、因常规临床需要在急诊科接受 LP 的成年人，他们被随机分为 US 定位组或触诊脊柱标志组。主要结局是针插入次数和操作成功率。次要结局是与操作相关的疼痛、操作时间、创伤性穿刺次数和患者对操作的满意度。
本研究共纳入 100 例患者，每组 50 例。两组在年龄、性别、体重指数（BMI）、LP 指征和触诊标志的难易程度方面无显著差异。在主要结局和次要结局方面，US 定位组与单独触诊组之间均无显著差异。
这些数据并未表明 LP 插入时常规使用 US 定位有任何优势，但可能需要进一步研究，以观察在难以触诊或肥胖患者亚组中是否有获益。
