Abstract

Successful first diagnostic lumbar puncture (LP) is crucial because intrathecal chemotherapy has not yet protected the central nervous system against cancer cells. If blood contaminates the cerebrospinal fluid (CSF) with blasts, they may enter the central neural system and compromise the patient’s health. We retrospectively determined the incidence of traumatic lumbar punctures (TLP) in 2,507 LPs of 250 pediatric hemato-oncology patients aged from one to 18 years, including both diagnostic and intrathecal treatment procedures, and 2,617 LPs of 1,525 other age-matched pediatric patients. We used ≥10 erythrocytes/µL in the CSF sample as the criterion of TLP. TLPs were less frequent in hemato-oncology patients than in other patients (31.6% vs. 48.5%, p < 0.0001). The incidence of TLP was significantly lower in the first diagnostic LP than in subsequent intrathecal treatment LPs (20.5% vs. 31.6%, p = 0.0046). According to logistic regression analysis, the odds of TLP was 1.6-fold if the LP procedure was not performed in the hemato-oncology department. The odds of the patient’s next LP being traumatic were threefold if the previous first LP was traumatic. A week or less time between the first and next LP tripled the odds of TLP as well. The patient’s age category was not significantly associated with the incidence of TLP. Given the risks of TLP, hemato-oncology patients’ first diagnostic LP should include administration of chemotherapy, as generally recommended, and be performed under general anesthesia or deep sedation by an experienced physician to optimize not only the success of the first LP procedure but also following procedures.

摘要

成功的首次诊断性腰椎穿刺 (LP) 至关重要，因为鞘内化疗尚未保护中枢神经系统免受癌细胞的侵害。如果血液用爆炸物污染脑脊液 (CSF)，它们可能会进入中枢神经系统并危及患者的健康。我们回顾性地确定了 250 名 1 至 18 岁儿童血液肿瘤患者的 2,507 例腰椎穿刺 (TLP) 的发生率，包括诊断和鞘内治疗程序，以及 1,525 名其他年龄匹配的儿科患者的 2,617 例腰椎穿刺 (LP) 的发生率。我们在脑脊液样本中使用≥10 个红细胞/µL 作为 TLP 的标准。血液肿瘤患者的 TLP 频率低于其他患者（31.6% 对 48.5%，p < 0.0001)。第一次诊断性 LP 中 TLP 的发生率明显低于随后的鞘内治疗 LP（20.5% 对 31.6%，p = 0.0046)。根据逻辑回归分析，如果不在血液肿瘤科进行 LP 手术，TLP 的几率为 1.6 倍。如果之前的第一个 LP 是创伤性的，那么患者的下一个 LP 是创伤性的几率是三倍。第一个和下一个 LP 之间的一周或更短的时间也使 TLP 的几率增加了三倍。患者的年龄类别与 TLP 的发生率没有显着相关性。鉴于 TLP 的风险，血液肿瘤患者的第一次诊断性 LP 应包括一般建议的化疗，并由经验丰富的医生在全身麻醉或深度镇静下进行，以优化第一次 LP 手术的成功，以下程序。