Kapadia F N, Jha A N
Department of Intensive Care Medicine, P.D. Hinduja National Hospital, Bombay, India.
Br J Neurosurg. 1996 Dec;10(6):585-7. doi: 10.1080/02688699646907.
We report a prospective investigation of a bedside test to evaluate the role and safety of lumbar puncture in raised intracranial pressure in patients with subarachnoid haemorrhage. Fourteen patients who underwent aneurysm clipping following subarachnoid haemorrhage were studied. All patients had intraventricular drains and needed high volume cerebrospinal fluid (CSF) drainage to maintain the normal intracranial pressure. A lumbar puncture was performed in these patients and the simultaneous opening lumbar and ventricular pressures noted, CSF was then drained via the lumbar puncture, and the simultaneous closing lumbar and ventricular pressures noted. In all patients, the opening lumbar pressure was close to the ventricular pressure. In 13 of 14 patients, CSF drainage resulted in an equivalent and simultaneous fall of ventricular pressure. We concluded that simultaneous measurement of lumbar and ventricular CSF pressure before and after lumbar CSF drainage allows identification of candidates with differential cranial and lumbar pressures and therefore indicates safety or risk of lumbar CSF drainage.
我们报告了一项前瞻性研究，该研究采用一种床旁检测方法来评估腰椎穿刺在蛛网膜下腔出血患者颅内压升高时的作用及安全性。对14例蛛网膜下腔出血后接受动脉瘤夹闭术的患者进行了研究。所有患者均置入了脑室内引流管，且需要大量引流脑脊液（CSF）以维持正常颅内压。对这些患者进行了腰椎穿刺，并记录同时的开放腰椎压力和脑室压力，然后通过腰椎穿刺引流脑脊液，并记录同时的闭合腰椎压力和脑室压力。在所有患者中，开放腰椎压力均接近脑室压力。14例患者中有13例，脑脊液引流导致脑室压力同时等量下降。我们得出结论，在腰椎脑脊液引流前后同时测量腰椎和脑室脑脊液压力，能够识别出存在颅压与腰压差异的患者，从而表明腰椎脑脊液引流的安全性或风险。
