儿童腰椎穿刺后平卧时间长短对并发症的影响

Impact of supine recumbency duration on the complications after lumbar puncture in children

目的了解儿童腰椎穿刺后并发症情况，评估术后平卧1h和4h对于头痛、腰痛等腰椎穿刺术后并发症的发生率有无影响，为临床建立标准化的腰椎穿刺流程提供依据。方法选取2012年11月至2013年4月住院的年龄〉3岁且意识清楚需行诊断性腰椎穿刺患儿，共87例，由同一研究者按照统一流程进行腰椎穿刺，穿刺过程中记录穿刺次数、操作时间、留取脑脊液量，操作完成后进行随机分组，试验组予平卧、禁食水1h护理，对照组予常规护理（平卧、禁食水4h），由另一位与研究无关的住院医师连续观察5d，记录患儿有无出现头痛、腰痛等不适，记录症状出现的时间、部位、出现症状后采取的措施，症状持续时间等。采用，检验或Fisher’s精确概率法比较不同组头痛、腰痛等的发生率，采用Logistic回归分析方法探讨年龄、性别、穿刺次数、留取脑脊液量等因素对于头痛和腰痛的发生有无影响。结果儿童腰椎穿刺术后头痛总发生率为4．6％（4／87例），试验组（2．4％）和对照组（6．7％）发生率差异无统计学意义（P=0．617）。腰痛总发生率为19．5％（17／87例），2组发生率差异无统计学意义（试验组21．4％，对照组17．8％，P=0．668）。Logistic多因素回归分析表明年龄（P=0．011，OR：6．884，95％CI：1．398～33．906）和腰穿经历（P=0．018，OR=0．126，95％CI=0．026～0．618）是腰痛发生的影响因素，≥6岁儿童腰穿后发生腰痛的风险比〈6岁患儿大，既往有过2次以上腰穿经历的患儿出现腰痛的风险相对减低。结论儿童腰椎穿刺术后常见的并发症为头痛和腰痛，术后平卧、禁食水4h和1h与腰椎穿刺术后头痛和腰痛的发生无关。

Objective To evaluate the post-puncture complications in children,and to evaluate the difference in the occurrence rate of headache and backache between patients who bad 1 hour of supine recumbency and those who had 4 hours of supine recumbency,to provide evidence for the standardized lumbar puncture （LP） procedure of children. Methods Inpatients who were older than 3 and had diagnostic LP in the course of their treatment between Nov. 2012 and Apr. 2013 were enrolled. The LP was performed by the same investigator under the standardized institutional guideline for LP and the information of number of LP attempts,duration of LP and cerebrospinal fluid （CSF） drainage volume were recorded. After the procedure, all the children were randomly assigned into 2 groups ： the test group had supine recumbency for 1 hour after LP, and the control group had it for 4 hours. For the first 5 days following LP, reports of headache and backache were recorded by another physician who didn＇t participate in this study. The difference in the occurrence rate of headache and backache between test group and control group was assessed by the chi-square test or Fisher＇s probabilities in 2 × 2 table. And a Logistic regression analysis was performed to assess the risk factors for the occurrence of the headache and backache. Results The overall frequency of headache was 4.6% （4/87 cases）. The frequency of headache was not significantly different between the test group （2.4%） and control group （ 6.7% ） （ P = 0.617）. And the overall frequency of backache was 19.5% （ 17/87 cases） , and it was not significantly different between the 2 groups （test group：21.4% ,control group ：17. 8% ,P =0.668）. In a Logistic regression analysis,age （P = 0. 011, OR ：6. 884,95 % CI： 1. 398 - 33. 906 ） and the previous history of lumbar puncture （ P = 0. 018, OR ： 0. 126, 95% CI：0. 026 -0.618 ） were significant risk factors for the occurrence of backache. The risk of backache in children with more than 2 times of LP was decreased. And the risk was higher in the children older than 6 years than those younger than 6 years. Conclusions Headache and backache were the most frequent post-puncture complications in children. There was no difference between short duration （l hour） of supine recumbency and long duration （4 hours） in preventing the occurrence of headache and backache after LP.