Dieterich M, Brandt T
Eur Arch Psychiatry Neurol Sci. 1985;235(2):71-5. doi: 10.1007/BF00633475.
After lumbar puncture (LP) an epidural CSF leakage caused by delayed closure of a dural defect leads to a decrease in CSF pressure. The resultant venous dilatation as well as downward shift of the brain with traction on pain-sensitive blood vessels and nerves frequently evokes post-lumbar puncture headache (PLPH), when the patient assumes the upright position. In previous studies differing opinions have been expressed about the prophylactic value of the posture taken by the patient after LP. The present study was designed to evaluate the benefit of the decrease of hydrostatic CSF pressure on the dural rent, when the patient lies down in a prone position with the head tilted down at an angle of 10 degrees for 30 min immediately after LP: is it possible to accelerate the closure of the dural defect in this way and prevent PLPH? One group of patients (n = 78) lay in a prone position with the head tilted down at an angle of 10 degrees for 30 min, the other group (n = 82) rose immediately after LP. PLPH was found to be independent of the posture in both groups and affected 44% and 41% of the patients, respectively, so that there is no longer any justification for requiring patients to remain in bed after LP.
腰椎穿刺（LP）后，硬膜缺损延迟闭合导致硬膜外脑脊液漏，从而引起脑脊液压力降低。当患者处于直立位时，由此产生的静脉扩张以及大脑向下移位并牵拉对疼痛敏感的血管和神经，常常会引发腰穿后头痛（PLPH）。在以往的研究中，对于腰穿后患者采取的体位的预防价值存在不同观点。本研究旨在评估腰穿后患者立即俯卧，头部向下倾斜10度并保持30分钟，脑脊液静水压降低对硬膜裂口的益处：通过这种方式是否有可能加速硬膜缺损的闭合并预防腰穿后头痛？一组患者（n = 78）俯卧，头部向下倾斜10度并保持30分钟，另一组患者（n = 82）腰穿后立即起身。结果发现两组患者的腰穿后头痛均与体位无关，分别有44%和41%的患者出现该症状，因此，要求患者腰穿后卧床已不再有任何依据。
