Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA.
J Neurol. 2017 Oct;264(10):2075-2080. doi: 10.1007/s00415-017-8597-6. Epub 2017 Aug 23.
The purpose of the study was to evaluate patient outcomes, including success rates, factors associated with unsuccessful procedures and frequency of post-lumbar puncture headaches (PLPH), at a dedicated academic outpatient lumbar puncture (LP) clinic. All patients referred to our LP clinic between June 1, 2014 and May 31, 2015 were included in this consecutive observational series. We collected information about patient characteristics, operational parameters of the procedure, and complications. We also recorded rates of participation in biomedical research involving use of cerebrospinal fluid. Univariate analysis used Student's t test and Fisher's exact test. Logistic regression was used to determine independent risk factors associated with unsuccessful LP and PLPH. The mean age of patients referred to our LP clinic was 46 ± 17 years. Of the 307 referrals, 281 patients (92%) started the procedure, with successful acquisition of CSF in 267 (95%). Factors contributing to unsuccessful procedures included higher body mass index [odds ratio (OR) 1.8], older age (OR 1.9), and female sex (OR 10.3). The rate of PLPH was 5.7%. Younger age (OR 0.5), female sex (OR 6.9), high mean arterial pressure (OR 2.2), and a traumatic LP (OR 10.0) were identified as risk factors for PLPH. Notably, 202 patients (72%) consented to biomedical research. A standardized approach to outpatient LP demonstrates high procedural success rate, low PLPH rate, and high participation in biomedical research. Awareness of a group of patients at higher risk for complications including procedure failure or PLPH provides guidance for decision-making regarding referral to the outpatient LP clinic.
本研究旨在评估患者结局，包括成功率、与不成功操作相关的因素以及腰椎穿刺后头痛（PLPH）的发生频率，研究对象为一家专注于学术性门诊腰椎穿刺（LP）的诊所。本连续观察性研究纳入了 2014 年 6 月 1 日至 2015 年 5 月 31 日期间所有转诊至 LP 门诊的患者。我们收集了患者特征、操作参数和并发症等信息。我们还记录了参与涉及使用脑脊液的生物医学研究的比例。使用 Student's t 检验和 Fisher 确切检验进行单变量分析。采用逻辑回归确定与 LP 不成功和 PLPH 相关的独立风险因素。转诊至 LP 门诊的患者平均年龄为 46 ± 17 岁。在 307 例转介中，281 例（92%）开始进行操作，267 例（95%）成功获取脑脊液。导致操作不成功的因素包括较高的体重指数[比值比（OR）1.8]、年龄较大（OR 1.9）和女性（OR 10.3）。PLPH 的发生率为 5.7%。年龄较小（OR 0.5）、女性（OR 6.9）、平均动脉压较高（OR 2.2）和创伤性 LP（OR 10.0）是 PLPH 的危险因素。值得注意的是，202 例（72%）患者同意参与生物医学研究。门诊 LP 的标准化方法具有较高的操作成功率、较低的 PLPH 发生率和较高的生物医学研究参与率。认识到一组存在并发症风险较高的患者，包括操作失败或 PLPH，为将患者转介至门诊 LP 诊所提供了决策指导。
