在患有和没有凝血病的患者中,腰椎穿刺与脊柱血瘤的关联
Jacob Bodilsen1, Theis Mariager1, Hannah Holm Vestergaard1
1Departments of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark.
JAMA
|October 13, 2020
概括
医生可以对患有凝血病的患者进行腰部穿刺,因为脊髓血瘤的风险很低 (0. 23%). 这项研究在患有凝血病和没有凝血病的患者中发现了类似的脊髓血瘤风险,这表明它可能不是一个禁忌.
科学领域:
- 神经学
- 血液学
- 临床医学
背景情况:
- 在进行腰部穿刺之前, 凝血病可能会导致医生犹.
- 对于临床决策至关重要的是了解脊柱血瘤的风险.
研究的目的:
- 评估患有凝血病或没有凝血病的患者的腰部穿刺后脊髓血瘤的风险.
- 确定影响腰部穿刺后脊髓血瘤风险的因素.
主要方法:
- 在丹麦 (2008年至2019年) 进行全国性基于人口的队列研究.
- 在64,730个个体中发现了83,711个腰部穿孔.
- 通过血小板计数,INR和APTT定义的凝血病;评估了30天的脊髓血瘤风险.
主要成果:
- 在没有凝血病的患者中,脊柱血瘤风险为0. 20%,而在凝血病患者中为0. 23%.
- 男性的性别和年龄 (41- 80岁) 是脊髓血瘤的独立危险因素.
- 随着INR和APTT水平的升高,出现创伤性腰部穿刺的风险增加.
结论:
- 腰部穿刺后脊髓血瘤的风险很低,即使在患有凝血病的患者中也是如此.
- 研究结果表明凝血症可能不是腰部穿刺的绝对禁忌.
- 医生在选择患者进行腰部穿刺时可能会影响观察到的比率.
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