腰椎穿刺をどのように行い,結果を分析して細菌性髄膜炎を診断するのですか?

Sharon E Straus¹, Kevin E Thorpe, Jayna Holroyd-Leduc

¹Division of General Internal Medicine, University of Calgary, Alberta. sharon.straus@utoronto.ca

JAMA

|October 26, 2006

まとめ

アトラウマ性針を使用し,診断性腰椎穿刺 (LPs) 時にスタイレットを再挿入すると,頭痛のリスクが軽減されます. 脳脊髄液 (CSF) の分析により,細菌性髄膜炎を正確に診断できます.

科学分野:

神経学神経学とは
感染症感染症は感染症です.
医療の手続き医療の手続き

背景:

診断用腰椎穴 (LPs) は,髄膜炎を排除するために不可欠ですが,有害事象のリスクがあります.
LP技術と脳脊髄液 (CSF) 分析の精度に関する証拠の体系的なレビュー.

研究の目的:

有害事象を最小限に抑える診断LP技術をレビューする.
大人の細菌性髄膜炎のCSF分析のテスト精度を評価する.

主な方法:

ランダム化試験と診断精度研究の体系的レビュー.
コクレーン・ライブラリー,MEDLINE,EMBASEのデータベースで検索しました.
データ抽出と2人の独立した調査員による品質評価.

主要な成果:

アトラウマ性針は,LP後の頭痛を軽減する傾向が非有意であることが示されました.
針を外す前にスタイレットを再び挿入すると,頭痛のリスクが著しく低下しました.
CSFのグルコース比率 ≤0.4,WBC数 ≥500/μL,乳酸 ≥3.5 mmol/Lを正確に診断した細菌性髄膜炎.

結論:

小口径の無傷針は,診断されたLPの後に頭痛のリスクを減らすことができます.
スティレットの再挿入は推奨されますが,LP後の通常のベッドレストは不要です.
将来の研究は,LPの成功と手続き訓練の最適化に焦点を当てなければならない.

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