Sternbach G
J Emerg Med. 1985;2(3):199-203. doi: 10.1016/0736-4679(85)90397-x.
Lumbar puncture has been in widespread clinical use for nearly a century. It is used in emergency medicine primarily as a tool for the diagnosis of meningoencephalitis and subarachnoid hemorrhage. The development of computed tomography has changed the position that lumbar puncture has held in the diagnostic sequence of a number of clinical entities. The procedure is contraindicated if there is soft-tissue infection adjacent to the puncture site and if there are findings of increased intracranial pressure due to a mass lesion. Performance in the setting of a coagulopathy may also be hazardous. The most serious potential complication is cerebral herniation. The commonest complication is postlumbar puncture headache, which is due to CSF hypotension resulting from persistent spinal fluid leakage through the meningeal puncture site. Spinal hematoma, diplopia, and intraspinal dermoid tumor formation are less common complications. Meningitis has been found to follow lumbar puncture in children with bacteremia. The lumbar puncture is a useful test for providing information regarding the cellular, chemical, and microbiologic composition of the CSF. Fluid obtained should be evaluated for cell count, Gram's stain, bacterial culture, glucose and protein levels, and other tests as clinically indicated.
腰椎穿刺已在临床广泛应用近一个世纪。它在急诊医学中主要用作诊断脑膜脑炎和蛛网膜下腔出血的工具。计算机断层扫描的发展改变了腰椎穿刺在许多临床疾病诊断顺序中的地位。如果穿刺部位附近有软组织感染，或者存在因占位性病变导致颅内压升高的迹象，则该操作是禁忌的。在凝血功能障碍的情况下进行该操作也可能有危险。最严重的潜在并发症是脑疝。最常见的并发症是腰穿后头痛，这是由于脑脊液通过脑膜穿刺部位持续渗漏导致脑脊液压力过低所致。脊髓血肿、复视和椎管内皮样肿瘤形成是较不常见的并发症。已发现菌血症患儿腰穿后会发生脑膜炎。腰椎穿刺是一项有用的检查，可提供有关脑脊液细胞、化学和微生物组成的信息。所获取的液体应进行细胞计数、革兰氏染色、细菌培养、葡萄糖和蛋白质水平评估，以及根据临床指征进行其他检查。
