Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
Neurodevelopmental and Behavioral Phenotyping Service, National Institute of Mental Health, NIH, DHHS, Bethesda, Maryland.
Pediatr Neurol. 2021 Jan;114:35-39. doi: 10.1016/j.pediatrneurol.2020.10.001. Epub 2020 Oct 9.
The purpose of the study was to evaluate the incidence of postdural puncture headache in a predominantly pediatric sample before and after a transition from conventional to atraumatic spinal needles.
In this retrospective cohort study, we analyzed data from 1059 lumbar puncture procedures in 181 individuals enrolled in NIH Clinical Center research protocols. Multivariate logistic regression was used to evaluate the association between postdural puncture headache and spinal needle type after adjusting for patient age, sex, and body mass index. A random effect of participant was used to accommodate repeated observations.
The median age at time of procedure was 15.3 years. The overall rate of postdural puncture headache was 5.1% (54 of 1059). With conventional needles and atraumatic needles, respectively, the rate of postdural puncture headache was 7.7% (43 of 588) and 2.3% (11 of 471); (odds ratio 0.32, 95% confidence interval 0.15 to 0.68).
Lumbar puncture for cerebrospinal fluid collection is an essential and common procedure in pediatric clinical care and research. Postdural puncture headache is the most common adverse event of the lumbar puncture procedure. Our data indicate that lumbar puncture is safe in pediatrics and that use of an atraumatic spinal needle further reduces the risk of postdural puncture headache.
本研究旨在评估在从传统到无创伤性脊柱针转变之前和之后，在主要为儿科样本中发生的硬膜后穿刺头痛的发生率。
在这项回顾性队列研究中，我们分析了在 NIH 临床中心研究方案中纳入的 181 名个体的 1059 例腰椎穿刺程序的数据。使用多变量逻辑回归来评估在调整患者年龄、性别和体重指数后，硬膜后穿刺头痛与脊柱针类型之间的关联。使用参与者的随机效应来适应重复观察。
手术时的中位年龄为 15.3 岁。硬膜后穿刺头痛的总体发生率为 5.1%（54/1059）。分别使用传统针和无创伤性针时，硬膜后穿刺头痛的发生率分别为 7.7%（43/588）和 2.3%（11/471）；（比值比 0.32，95%置信区间 0.15 至 0.68）。
腰椎穿刺以收集脑脊液是儿科临床护理和研究中必不可少且常见的程序。硬膜后穿刺头痛是腰椎穿刺程序最常见的不良事件。我们的数据表明，腰椎穿刺在儿科中是安全的，并且使用无创伤性脊柱针进一步降低了硬膜后穿刺头痛的风险。
