Bertolotto Antonio, Malentacchi Maria, Capobianco Marco, di Sapio Alessia, Malucchi Simona, Motuzova Yana, Pulizzi Annalisa, Berchialla Paola, Sperli Francesca
Neurologia 2-CRESM (Centro Riferimento Regionale Sclerosi Multipla), AOU San Luigi, Italy
Neurologia 2-CRESM (Centro Riferimento Regionale Sclerosi Multipla), AOU San Luigi, Italy.
Cephalalgia. 2016 Feb;36(2):131-8. doi: 10.1177/0333102415583983. Epub 2015 Apr 23.
The objectives of this article are to test the feasibility of lumbar puncture (LP) using 25-gauge (G) needles in daily neurological practice and to compare the risk of post-dural puncture headache (PDPH) with four types of needles.
In a prospective rater-blind study, pros and cons of four different LP needles, the 20G Quincke (20Q), 22G Sprotte (22S), 25G Whitacre (25W) and 25G Sprotte (25S), were evaluated in 394 LPs performed by seven neurologists. The neurologist performing the LP recorded the type and size of needle, intensity of pain, safety, time of the procedure and failure or success. Between five and 15 days later another neurologist, blind to the type of needle used, completed an ad-hoc questionnaire for PDPH.
PDPH developed in 35.9% patients when using a 20Q needle, and in 12.9%, 6.8% and 1.6%, respectively, when using a 22S, 25W or 25S needle. The difference in incidence of PDPH following LP performed with the 20Q needle and the 25S or 22S was statistically significant (p < 0.001 and p = 0.008, respectively) and it approached significance when comparing the 25S and 25W (p = 0.06). As 25W and 25S needles need CSF aspiration, LP requires more time and skill. Pain caused by LP was similar with the four needles.
The use of the 25S needle in diagnostic LP reduces the frequency and severity of PDPH.
本文的目的是检验在日常神经科实践中使用25号（G）针头进行腰椎穿刺（LP）的可行性，并比较四种类型针头发生硬膜穿刺后头痛（PDPH）的风险。
在一项前瞻性评分者盲法研究中，对七名神经科医生进行的394次腰椎穿刺中，评估了四种不同腰椎穿刺针（20G Quincke针（20Q）、22G Sprotte针（22S）、25G Whitacre针（25W）和25G Sprotte针（25S））的优缺点。进行腰椎穿刺的神经科医生记录针头的类型和尺寸、疼痛强度、安全性、操作时间以及穿刺失败或成功情况。在五至十五天后，另一名对所使用针头类型不知情的神经科医生完成一份关于PDPH的特设问卷。
使用20Q针时，35.9%的患者发生了PDPH，而使用22S、25W或25S针时，发生率分别为12.9%、6.8%和1.6%。使用20Q针与25S针或22S针进行腰椎穿刺后PDPH发生率的差异具有统计学意义（分别为p < 0.001和p = 0.008），比较25S针和25W针时差异接近显著水平（p = 0.06）。由于25W针和25S针需要抽取脑脊液，腰椎穿刺需要更多时间和技巧。四种针引起的疼痛相似。
在诊断性腰椎穿刺中使用25S针可降低PDPH的发生率和严重程度。
