抽脊髓的针影响并发症风险
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By LabMedica International staff writers Posted on 10 Jan 2018 |
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图片：腰椎穿刺所用的两根针，上图：无创伤式针能减少并发症；下图：老式针刺穿硬脊膜（图片蒙南部总医院惠赐）。
腰椎穿刺俗称抽脊髓，是诊断和治疗疾病的一项常规手术。大概35%的患者会出现硬脊膜穿刺后头痛，有时引起伤筋动骨般的疼痛，使患者不得不返回医院开止疼片或接受创伤性更大的治疗。
有人提出针尖设计会影响硬脊膜穿刺后头痛的发生率，认为铅笔头形的“无创伤”式针引起的并发症少于带斜角的“创伤”式针。尽管如此，临床医师却仍很少使用无创伤式针，甚至不知道它的存在。
位于加拿大安大略省汉密尔顿的麦克马斯特大学的医学科学家搜索已发表的随机对照实验(RCT)、观察性研究和文摘，不限发表形式和语种。他们检查了头痛的预后及其类型、强度、持续时间和治疗手段，还检查了背痛、成功率、听觉障碍和神经根刺激的预后。主要结果指标是硬脊膜穿刺后头痛的发病率。该研究汇集了110项临床实验的数据，共有过去28年间来自29个国家的3万多名参与者。
科研小组发现，用无创伤式针代替传统的创伤式针做腰椎穿刺同样有效，且使头痛、需要静脉输液或受控镇痛、神经根刺激和听觉障碍这些并发症大幅减少。他们解释道，老式针针尖的锋利边缘割开组织向前钻，而无创伤式针的针尖使周围的组织膨胀并收缩。无创伤式针在硬脊膜留下的小洞使得脑脊液更难渗透，因而减少了头痛、再入院和治疗的频率。他们还发现无创伤式针的成本是老式针的一到三倍。
该研究的论文发表于2017年12月6日的《柳叶刀》杂志。资深作者、神经外科医生Saleh A. Almenawer大夫说：“无创伤式针使头痛发生率降低了50%以上，病人再入院和返回急诊室开镇痛药或做硬膜外血补片的概率也减少50%以上。两种针的区别在于穿过包绕神经的硬脊膜这层厚膜的方式。这项研究提供了令人信服的高质量证据，让人们可以放心地换用无创伤式针，从而改进病人护理。”
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麦克马斯特大学
有人提出针尖设计会影响硬脊膜穿刺后头痛的发生率，认为铅笔头形的“无创伤”式针引起的并发症少于带斜角的“创伤”式针。尽管如此，临床医师却仍很少使用无创伤式针，甚至不知道它的存在。
位于加拿大安大略省汉密尔顿的麦克马斯特大学的医学科学家搜索已发表的随机对照实验(RCT)、观察性研究和文摘，不限发表形式和语种。他们检查了头痛的预后及其类型、强度、持续时间和治疗手段，还检查了背痛、成功率、听觉障碍和神经根刺激的预后。主要结果指标是硬脊膜穿刺后头痛的发病率。该研究汇集了110项临床实验的数据，共有过去28年间来自29个国家的3万多名参与者。
科研小组发现，用无创伤式针代替传统的创伤式针做腰椎穿刺同样有效，且使头痛、需要静脉输液或受控镇痛、神经根刺激和听觉障碍这些并发症大幅减少。他们解释道，老式针针尖的锋利边缘割开组织向前钻，而无创伤式针的针尖使周围的组织膨胀并收缩。无创伤式针在硬脊膜留下的小洞使得脑脊液更难渗透，因而减少了头痛、再入院和治疗的频率。他们还发现无创伤式针的成本是老式针的一到三倍。
该研究的论文发表于2017年12月6日的《柳叶刀》杂志。资深作者、神经外科医生Saleh A. Almenawer大夫说：“无创伤式针使头痛发生率降低了50%以上，病人再入院和返回急诊室开镇痛药或做硬膜外血补片的概率也减少50%以上。两种针的区别在于穿过包绕神经的硬脊膜这层厚膜的方式。这项研究提供了令人信服的高质量证据，让人们可以放心地换用无创伤式针，从而改进病人护理。”
Related Links:
麦克马斯特大学
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