CAJ | 학술논문

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x2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.
목적 료해인동요추천자후병발증정황,평고술후평와1h화4h대우두통、요통등요추천자술후병발증적발생솔유무영향,위림상건립표준화적요추천자류정제공의거.방법 선취2012년11월지2013년4월주원적년령＞3세차의식청초수행진단성요추천자환인,공87례,유동일연구자안조통일류정진행요추천자,천자과정중기록천자차수、조작시간、류취뇌척액량,조작완성후진행수궤분조,시험조여평와、금식수1h호리,대조조여상규호리(평와、금식수4h),유령일위여연구무관적주원의사련속관찰5d,기록환인유무출현두통、요통등불괄,기록증상출현적시간、부위、출현증상후채취적조시,증상지속시간등.채용x2검험혹Fisher's정학개솔법비교불동조두통、요통등적발생솔,채용Logistic회귀분석방법탐토년령、성별、천자차수、류취뇌척액량등인소대우두통화요통적발생유무영향.결과 인동요추천자술후두통총발생솔위4.6％ (4/87례),시험조(2.4％)화대조조(6.7％)발생솔차이무통계학의의(P =0.617).요통총발생솔위19.5％(17/87례),2조발생솔차이무통계학의의(시험조21.4％,대조조17.8％,P=0.668).Logistic다인소회귀분석표명년령(P=0.011,OR:6.884,95％ CI:1.398～33.906)화요천경력(P=0.018,OR:0.126,95％ CI:0.026 ～0.618)시요통발생적영향인소,≥6세인동요천후발생요통적풍험비＜6세환인대,기왕유과2차이상요천경력적환인출현요통적풍험상대감저.결론 인동요추천자술후상견적병발증위두통화요통,술후평와、금식수4h화1h여요추천자술후두통화요통적발생무관.
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 had 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 =0.018,0R: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 (1 hour) of supine recumbency and long duration (4 hours) in preventing the occurrence of headache and backache after LP.