Rusch Rebecca, Schulta Christina, Hughes Laura, Withycombe Janice S
Oncology, Medical College of Wisconsin, Milwaukee, WI, USA.
Children's Hospital of Wisconsin, Milwaukee, WI, USA.
J Pediatr Oncol Nurs. 2014 Jul;31(4):230-238. doi: 10.1177/1043454214532026.
Post-lumbar puncture headaches (PLPHs) are a known complication of lumbar puncture procedures. Children undergoing treatment for cancer often undergo multiple lumbar punctures, placing them at increased risk for PLPHs. There are currently no guidelines for the prevention or management of PLPHs in children. A team was therefore assembled to conduct a systematic review of the evidence in relationship to PLPHs in the pediatric population. Clinical questions were developed and used to guide the literature review. Twenty-four articles were deemed appropriate for use and were evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Based on the review of evidence, strong recommendations are made for the use of smaller needle sizes and for the use of pencil point needles during lumbar puncture procedures. Weak recommendations are made for needle orientation and positioning following the procedure as well as for interventions used to treat PLPHs once they occur. There is a need for additional, pediatric-specific studies to further examine the issue of PLPH prevention and treatment.
腰穿后头痛（PLPHs）是腰穿操作已知的一种并发症。接受癌症治疗的儿童经常要进行多次腰穿，这使他们发生腰穿后头痛的风险增加。目前尚无针对儿童腰穿后头痛预防或管理的指南。因此，组建了一个团队对儿科人群中与腰穿后头痛相关的证据进行系统评价。制定了临床问题并用于指导文献综述。24篇文章被认为适合使用，并根据推荐分级评估、制定与评价（GRADE）标准进行评估。基于证据综述，强烈推荐在腰穿操作中使用较小型号的针头以及铅笔头针。对于腰穿操作后针头的方向和位置以及腰穿后头痛发生后用于治疗的干预措施，给出了弱推荐。需要开展更多针对儿科的研究，以进一步探讨腰穿后头痛的预防和治疗问题。
