Sanguanwit Pitsucha, Tansuwannarat Phantakan, Bua-Ngam Chinnarat, Suttabuth Supakrid, Atiksawedparit Pongsakorn, Trakulsrichai Satariya
Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand.
Arch Acad Emerg Med. 2023 Aug 21;11(1):e59. doi: 10.22037/aaem.v11i1.2026. eCollection 2023.
Previous studies have shown higher lumbar puncture (LP) success rates when using ultrasound guidance. This study aimed to compare the first-attempt success rate of ultrasound-guided LP with blind technique of needle insertion using the palpable spinal surface landmark in patients with obesity or a difficult anatomy.
This prospective randomized controlled study was performed at the emergency department of Ramathibodi Hospital, an academic tertiary university hospital, from August 2015 to July 2016.
40 patients were enrolled (20 surface landmark-guided and 20 ultrasound-guided LPs). 52.5% of the patients were male with the mean age of 60.33 ± 4.24 years. The first-attempt success rate in the ultrasound-guided LP group was significantly higher than the landmark-guided LP group (80% vs. 35%, respectively), with risk difference (RD) of 45.00% (95% confidence interval (CI): 17.72%, 72.28%). This indicated absolute risk reduction and number needed to treat of 45.00% and 2.22, respectively. The median procedural duration required to achieve successful LP in the ultrasound-guided LP group was significantly shorter than the surface landmark-guided LP group (5 [IQR: 3-18] minutes vs. 13.5 [IQR: 5-30] minutes, respectively). Traumatic puncture as a complication occurred less frequently in the ultrasound-guided LP group than the surface landmark-guided LP group with risk ratio (RR) = 0.33 (95% CI: 0.08, 1.46) and RD = -20.00% (95% CI: -44.00%, 4.00%). This indicated absolute risk reduction and number needed to harm of 20.00% and 5.00, respectively. However, the difference was not significant.
Using ultrasound to help localize the insertion point before LP increased the first-attempt success rate and improved other LP outcomes in Thai patients with obesity or a difficult anatomy. It also shortened the procedural duration and reduced the incidence of traumatic tap.
既往研究表明，使用超声引导时腰椎穿刺（LP）成功率更高。本研究旨在比较超声引导下LP与使用可触及的脊柱表面标志进行盲目进针技术在肥胖或解剖结构复杂患者中的首次尝试成功率。
本前瞻性随机对照研究于2015年8月至2016年7月在拉玛蒂博迪医院急诊科进行，该医院为一所学术性三级大学医院。
共纳入40例患者（20例采用表面标志引导下LP，20例采用超声引导下LP）。52.5%的患者为男性，平均年龄为60.33±4.24岁。超声引导下LP组的首次尝试成功率显著高于表面标志引导下LP组（分别为80%和35%），风险差异（RD）为45.00%（95%置信区间（CI）：17.72%，72.28%）。这表明绝对风险降低率和治疗所需人数分别为45.00%和2.22。超声引导下LP组成功进行LP所需的中位操作时间显著短于表面标志引导下LP组（分别为5[四分位间距：3 - 18]分钟和13.5[四分位间距：5 - 30]分钟）。超声引导下LP组作为并发症的创伤性穿刺发生率低于表面标志引导下LP组，风险比（RR）=0.33（95%CI：0.08，1.46），RD = - 20.00%（95%CI：- 44.00%，4.00%）。这表明绝对风险降低率和伤害所需人数分别为20.00%和5.00。然而，差异无统计学意义。
在LP前使用超声帮助定位进针点可提高泰国肥胖或解剖结构复杂患者的首次尝试成功率，并改善其他LP结局。它还缩短了操作时间并降低了创伤性穿刺的发生率。
