Department of Neurology, Nîmes University Hospital, 4, Rue du Pr Debré, 30029, Nîmes Cedex 9, France.
Institut de Génomique Fonctionnelle, UMR5203, Université Montpellier, Montpellier, France.
Neurol Sci. 2017 Dec;38(12):2189-2193. doi: 10.1007/s10072-017-3142-z. Epub 2017 Oct 10.
The objective of this study is to analyze CSF red blood cell (RBC) count from first-attempt lumbar punctures and to analyze parameters associated with first-attempt lumbar punctures and hemorrhagic lumbar puncture. This is a prospective analysis of consecutive patients who underwent lumbar puncture for any reason other than suspected acute subarachnoid hemorrhage. Analyzed parameters were the following: age, indication for lumbar puncture, aPTT ratio, PTT, platelet count, patient's position, needle type (atraumatic/standard), needle diameter, person performing lumbar puncture (medical student/resident/attending physician), number of lumbar levels punctured, necessity of needle repositioning, CSF RBC and white blood cell count, and protein level. Lumbar puncture resulting in RBC count > 5 RBC/mm was classified as hemorrhagic lumbar puncture (different cut-offs were studied: > 5/> 10/> 100/> 500/> 1000 RBC). In total, 169 elective lumbar punctures in 165 different patients were included. First-attempt lumbar puncture occurred in 22% > 5 RBC, in 19.5% > 10 RBC, in 4.5% > 100 RBC, in 3% > 500 RBC, and 1.5% > 1000 RBC count. First-attempt lumbar puncture was associated with non-hemorrhagic lumbar puncture for each of the RBC count cut-offs (OR for non-hemorrhagic lumbar puncture in first-attempt lumbar puncture 2.8, 95% CI 1.4-5.7). The presence of a hemorrhagic disorder (concerning cerebral amyloid angiopathy in all patients) and higher aPTT ratio were associated with hemorrhagic lumbar puncture. Atraumatic needle use was associated with non-hemorrhagic lumbar puncture for RBC count cut-offs ≤ 5 and ≤ 10 RBC (OR for non-hemorrhagic lumbar puncture in atraumatic needle use 2.5 [95% CI 1.3-4.8] and 2.2 [95% CI 1.1-4.4], respectively). First-attempt lumbar puncture and hemorrhagic lumbar puncture were not associated with other parameters. Slightly elevated CSF RBC count after first-attempt lumbar puncture occurs relatively frequently, but is even more frequent in non-first-attempt lumbar puncture. Atraumatic needle use is associated with non-hemorrhagic lumbar puncture.
本研究旨在分析首次腰椎穿刺的脑脊液（CSF）红细胞（RBC）计数，并分析与首次腰椎穿刺和出血性腰椎穿刺相关的参数。这是一项连续患者的前瞻性分析，这些患者因除疑似急性蛛网膜下腔出血以外的任何原因而行腰椎穿刺。分析的参数包括：年龄、腰椎穿刺的适应证、aPTT 比值、PTT、血小板计数、患者体位、针型（无创伤/标准）、针直径、行腰椎穿刺的人员（医学生/住院医师/主治医生）、穿刺的腰椎节段数、需要重新定位针、CSF RBC 和白细胞计数以及蛋白水平。CSF RBC 计数>5 RBC/mm 的腰椎穿刺被归类为出血性腰椎穿刺（研究了不同的截止值：>5/>10/>100/>500/>1000 RBC）。共纳入 165 名患者的 169 例择期腰椎穿刺。22%的首次腰椎穿刺>5 RBC，19.5%的首次腰椎穿刺>10 RBC，4.5%的首次腰椎穿刺>100 RBC，3%的首次腰椎穿刺>500 RBC，1.5%的首次腰椎穿刺>1000 RBC。对于每个 RBC 计数截止值，首次腰椎穿刺均与非出血性腰椎穿刺相关（首次腰椎穿刺中非出血性腰椎穿刺的 OR 为 2.8，95%CI 1.4-5.7）。出血性疾病（所有患者均为脑淀粉样血管病）和较高的 aPTT 比值与出血性腰椎穿刺相关。无创伤针的使用与 RBC 计数截止值≤5 和≤10 RBC 的非出血性腰椎穿刺相关（无创伤针使用的非出血性腰椎穿刺的 OR 分别为 2.5[95%CI 1.3-4.8]和 2.2[95%CI 1.1-4.4]）。首次腰椎穿刺和出血性腰椎穿刺与其他参数无关。首次腰椎穿刺后 CSF RBC 计数略有升高相对较为常见，但在非首次腰椎穿刺中更为常见。无创伤针的使用与非出血性腰椎穿刺相关。
