Dinsmore J, Bacon R C, Hollway T E
Department of Anaesthesia, Atkinson Morley's Hospital, London, UK.
Anaesthesia. 1998 May;53(5):431-4. doi: 10.1046/j.1365-2044.1998.00333.x.
The effects of increasing degrees of flexion on cerebrospinal fluid pressure were investigated in 12 neurosurgical patients requiring lumbar subarachnoid drains. Cerebrospinal fluid pressure and central venous pressure were measured in three positions: fully flexed ('chin on chest'), flexed at ninety degrees and straight. There was a significant increase in cerebrospinal fluid pressure on moving from the fully flexed to the flexed position (p < 0.0001), but not from the flexed to the straight position. These results were mirrored by smaller changes in central venous pressure. In patients without intracranial pathology these increases in cerebrospinal fluid pressure are probably unimportant. However, intracranial pathology may result in low cerebral perfusion pressures and any increase in cerebrospinal fluid pressure in this group may be harmful. The fully flexed position should be avoided when inserting lumbar drains in at risk patients.
在12例需要腰蛛网膜下腔引流的神经外科患者中，研究了不同程度屈曲对脑脊液压力的影响。在三个体位测量脑脊液压力和中心静脉压：完全屈曲（“下巴抵胸”）、90度屈曲和伸直位。从完全屈曲位转变为屈曲位时，脑脊液压力显著升高（p<0.0001），但从屈曲位转变为伸直位时则无显著变化。中心静脉压的较小变化也呈现出类似结果。在没有颅内病变的患者中，这些脑脊液压力的升高可能并不重要。然而，颅内病变可能导致脑灌注压降低，该组患者脑脊液压力的任何升高都可能有害。在有风险的患者中插入腰引流管时应避免完全屈曲位。
