Lancet:用无创穿刺针进行腰椎穿刺可显著降低穿刺后头痛的发生率。

2017-12-07 MedSci MedSci原创

既往已建议用无创穿刺针来降低腰椎穿刺后并发症的发生率。但据调查显示,这种穿刺针在临床的应用率仍然很低。现研究人员进行系统回顾和Meta-分析,比较患者用无创穿刺针或常规穿刺针进行腰椎穿刺的预后。研究人员从13个数据库中检索2017年8月15日前发表的比较用无创穿刺针和常规穿刺针进行腰椎穿刺的预后的随机对照试验。排除未进行硬膜外穿刺或未用常规穿刺针作对照的试验。主要评估指标是根据随机效应和固定效果的

既往已建议用无创穿刺针来降低腰椎穿刺后并发症的发生率。但据调查显示,这种穿刺针在临床的应用率仍然很低。现研究人员进行系统回顾和Meta-分析,比较患者用无创穿刺针或常规穿刺针进行腰椎穿刺的预后。

研究人员从13个数据库中检索2017年8月15日前发表的比较用无创穿刺针和常规穿刺针进行腰椎穿刺的预后的随机对照试验。排除未进行硬膜外穿刺或未用常规穿刺针作对照的试验。主要评估指标是根据随机效应和固定效果的荟萃分析所评估的穿刺后头疼的发生率,以及附加的安全性和效果预后。

20 241篇报道,经筛选后,110个试验,包含31 412位受试者,纳入分析。与常规穿刺针相比,无创穿刺针组穿刺后头疼的发生率显着降低(4.2%[95% CI 3.3-52] vs 11.0%[9.1-13.3];相当风险0.40,95% CI 0.34-0.47,p<0.0001;I2=45.4%)。无创穿刺针同时还可显着降低静脉输液量及自控式镇痛(0.44,95% CI 0.29-0.64;p<0.0001)、穿刺点敷贴用量(0.50,0.33–0.75;p=0.001)、任何头痛(0.50,0.43–0.57;p<0.0001)、轻度头疼(0.52,0.38–0.70;p<0.0001)、重度头疼(0.41,0.28–0.59;p<0.0001)、神经根刺激(0.71,0.54–0.92;p=0.011)和听力障碍(0.25,0.1–0.60;p=0.002)。两组间首次穿刺成功、失败率、平均穿刺次数以及穿刺点创伤和腰疼的发生率均无明显差异。

在进行腰椎穿刺的患者中,无创穿刺针可减少穿刺后头疼的发生率,并可减少患者再次入院进行额外治疗的需要,并且可取得与常规穿刺针一样的效果。上述结果提示,无创穿刺针是进行腰椎穿刺的一个优质选择。

原始出处:

Siddharth Nath,et al.Atraumatic versus conventional lumbar puncture needles: a systematic review and meta-analysis.The Lancet. 06 December 2017.http://dx.doi.org/10.1016/S0140-6736(17)32451-0

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    2018-10-23 howi
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    2017-12-13 hfuym10906

    学习了学习了学习了学习了学习了

    0

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    2017-12-13 hfuym10906

    学习了

    0

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    2017-12-09 rgjl
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