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首页> 外文期刊>British journal of neurosurgery >Defending a traditional practice in the modern era: The use of lumbar puncture in the investigation of subarachnoid haemorrhage
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Defending a traditional practice in the modern era: The use of lumbar puncture in the investigation of subarachnoid haemorrhage

机译：捍卫现代传统做法：腰椎穿刺在蛛网膜下腔出血研究中的应用

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Introduction. Acute severe headache is a common medical presentation, and a common area of diagnostic uncertainty. Subarachnoid haemorrhage (SAH) is the cause in a minority of patients and has a high rate of morbidity and mortality. Therefore, its conclusive diagnosis with computed tomography (CT) or lumbar puncture (LP) is paramount. With advancement in imaging technology, emerging evidence now suggests that LP is no longer required for a subset of patients as CT has 100% sensitivity in detecting SAH, when performed under specific conditions. Objectives. To assess the proportion of patients with conclusive CSF xanthochromia results following a negative CT scan in suspected SAH to determine the diagnostic efficacy of LP. Methods. CSF bilirubin and oxyhaemoglobin spectrophotometric absorbance data from all centres in a regional health board were identified for consecutive patients over a 6-month period. Results were stratified as conclusive (positive or negative), or inconclusive according to national guidelines. Results. 239 of 255 (93.7%) results were conclusive: 89.0% were negative (227 of 255). 4.7% of results were positive (12 of 255), revealing 4 cerebral aneurysms requiring treatment. 16 out of 255 (6.3%) samples were inconclusive, yielding 1 aneurysm requiring treatment. In the same period, there were 27 CT-positive cases of SAH. Conclusions. LP has a high diagnostic yield, eliminating the need for neurosurgical opinion or investigation in almost 90% of cases. The test is both cost and time efficient and subjects only a small number of patients to the radiation and contrast risks of angiography.
机译：介绍。急性严重头痛是常见的医学表现，也是诊断不确定性的常见领域。蛛网膜下腔出血（SAH）是少数患者的病因，其发病率和死亡率很高。因此，其通过计算机断层扫描（CT）或腰穿（LP）的结论性诊断至关重要。随着成像技术的进步，现在出现的证据表明，当在特定条件下进行CT时，CT在检测SAH方面具有100％的灵敏度，因此不再需要一部分患者使用LP。目标。为了评估疑似SAH中CT扫描阴性后具有确定性CSF黄变色结果的患者比例，以确定LP的诊断效力。方法。在六个月的时间内，连续患者的区域卫生委员会所有中心的CSF胆红素和氧合血红蛋白分光光度法吸光度数据均已确定。根据国家指南，结果分为结论性（阳性或阴性）或不确定性分层。结果。 255个结果中的239个（93.7％）是结论性的：89.0％的结果为阴性（255个中的227个）。 4.7％的结果为阳性（255个中的12个），显示有4例需要治疗的脑动脉瘤。 255个样本中有16个（6.3％）尚无定论，产生1个需要治疗的动脉瘤。同期，有27例SAH的CT阳性病例。结论LP的诊断率很高，几乎有90％的病例无需进行神经外科意见或调查。该测试既节省成本又节省时间，并且仅使少数患者接受血管造影的放射线和造影剂风险。

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