透视引导下腰椎穿刺：透视时间及体重指数的影响——一项基线研究
Fluoroscopic-guided lumbar puncture: fluoroscopic time and implications of body mass index--a baseline study.
作者信息
Boddu S R, Corey A, Peterson R, Saindane A M, Hudgins P A, Chen Z, Wang X, Applegate K E
机构信息
From the Divisions of Neuroradiology (S.R.B., A.C., R.P., A.M.S., P.A.H.)
From the Divisions of Neuroradiology (S.R.B., A.C., R.P., A.M.S., P.A.H.).
出版信息
AJNR Am J Neuroradiol. 2014 Aug;35(8):1475-80. doi: 10.3174/ajnr.A3914. Epub 2014 Apr 10.
BACKGROUND AND PURPOSE
Fluoroscopic-guided lumbar puncture is an effective alternative to bedside lumbar puncture in challenging patients. However, no published guidelines are available for an acceptable range of fluoroscopic time for this procedure. The purpose of this study was to set department benchmark fluoroscopic times for lumbar puncture, accounting for body mass index in our patient population.
MATERIALS AND METHODS
We identified and reviewed all patients who underwent fluoroscopic-guided lumbar puncture at 4 hospitals during a 2-year period (July 2011 to June 2013). Data collection included patient information (demographics, body mass index, history of prior lumbar surgery and/or lumbar hardware, scoliosis); procedure details (fluoroscopic time, level of access, approach, needle gauge and length); level of operator experience; and hospital site. A generalized linear model was used to test whether body mass index influenced fluoroscopic time while controlling other factors.
RESULTS
Five hundred eighty-four patients (mean age, 47.8 ± 16.2 years; range, 16-92 years; 33% male) had successful fluoroscopic-guided lumbar puncture s. Mean body mass index and fluoroscopic time were higher in female patients (34.4 ± 9.9 kg/m(2) and 1.07 minutes; 95% CI, 0.95-1.20) than in male patients (29.2 ± 7.3 kg/m(2) and 0.91 minutes; 95% CI, 0.79-1.03). Body mass index (P = .001), hospital site (P < .001), and level of experience (P = .03) were factors significantly affecting fluoroscopic time on multivariate analysis. Benchmark fluoroscopic times in minutes were the following: 0.48 (95% CI, 0.40-0.56) for normal, 0.61 for overweight (95% CI, 0.52-0.71), 0.63(95% CI, 0.58-0.73) for obese, and 0.86 (95% CI, 0.74-1.01) in extremely obese body mass index categories.
CONCLUSIONS
In patients undergoing fluoroscopic-guided lumbar punctures, fluoroscopy time increased with body mass index We established benchmark fluoroscopic-guided lumbar puncture time ranges as related to body mass index in our patient population.
背景与目的
在一些具有挑战性的患者中，透视引导下腰椎穿刺是床旁腰椎穿刺的一种有效替代方法。然而，目前尚无关于该操作可接受透视时间范围的已发表指南。本研究的目的是确定我们患者群体中腰椎穿刺的科室透视时间基准，并考虑体重指数的影响。
材料与方法
我们识别并回顾了在2年期间（2011年7月至2013年6月）于4家医院接受透视引导下腰椎穿刺的所有患者。数据收集包括患者信息（人口统计学、体重指数、既往腰椎手术和/或腰椎内固定史、脊柱侧弯）；操作细节（透视时间、穿刺部位、进针路径、针的规格和长度）；操作者经验水平；以及医院地点。使用广义线性模型在控制其他因素的同时测试体重指数是否影响透视时间。
结果
584例患者（平均年龄47.8±16.2岁；范围16 - 92岁；33%为男性）成功接受了透视引导下腰椎穿刺。女性患者的平均体重指数和透视时间高于男性患者（分别为34.4±9.9kg/m²和1.07分钟；95%CI，0.95 - 1.20），男性患者为（29.2±7.3kg/m²和0.91分钟；95%CI，0.79 - 1.03）。多因素分析显示，体重指数（P = 0.001）、医院地点（P < 0.001）和经验水平（P = 0.03）是显著影响透视时间的因素。以分钟为单位的基准透视时间如下：正常体重者为0.48（95%CI，0.40 - 0.56），超重者为0.61（95%CI，0.52 - 0.71），肥胖者为0.63（95%CI，0.58 - 0.73），极度肥胖者为0.86（95%CI，0.74 - 1.01）。
结论
在接受透视引导下腰椎穿刺的患者中，透视时间随体重指数增加而增加。我们确定了与我们患者群体体重指数相关的透视引导下腰椎穿刺时间基准范围。
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