收集脑脊液(CSF)

定义

收集脑脊液(CSF) is a test to look at the fluid that surrounds the brain and spinal cord.

脑脊液起到缓冲作用，保护大脑和脊柱免受伤害. 液体通常是清澈的. 它和水的稠度一样. 该测试也用于测量脊髓液中的压力.

选择的名字

Spinal tap; Ventricular puncture; Lumbar puncture; Cisternal puncture; Cerebrospinal fluid culture

如何执行测试

有不同的方法来获取脑脊液样本. 腰椎穿刺(脊髓穿刺)是最常见的方法.

接受测试:

• You will lie on your side with your knees pulled up toward the chest, and chin tucked downward. 有时测试是坐着完成的，但身体向前弯曲.
• 背面清洁后, the health care provider will inject a local numbing medicine (anesthetic) into the lower spine.
• 将插入一根脊椎针.
• 有时采取开启压力. 异常的血压可能表明感染或其他问题.
• 一旦针头到位, 测量脑脊液压力后, a sample of 1 to 10 milliliters (mL) of CSF is collected in 4 vials.
• The needle is removed, the area is cleaned, and a bandage is placed over the needle site. You may be asked to remain lying down for a short time after the test.

In some cases, special x-rays are used to help guide the needle into position. 这叫做透视.

Lumbar puncture with fluid collection may also be part of other procedures such as an x-ray or CT scan after dye has been inserted into the CSF.

很少使用其他方法收集脑脊液.

• Cisternal puncture uses a needle placed below the occipital bone (back of the skull). 它可能很危险，因为它离脑干太近了. 它总是在透视或其他成像指导下完成.
• Ventricular puncture may be recommended in people with possible brain herniation. 它通常在手术室里进行. A hole is drilled in the skull, and a needle is inserted directly into one of the brain's ventricles.

CSF may also be collected from a tube that is already placed in the fluid, 比如分流或心室引流.

如何准备考试

You will need to give the health care team your consent before the test. Tell your provider if you are on any 阿斯匹林 or any other blood-thinning medicines.

After the procedure, you should plan to rest for several hours, even if you feel fine. This is to prevent fluid from leaking around the site of the puncture. 你不需要一直平躺着. 如果你感到头痛, 喝咖啡等含咖啡因的饮料可能会有帮助, 茶还是苏打水.

考试的感觉如何

在测试中保持姿势可能会不舒服. Staying still is important because movement may lead to injury of the spinal cord.

You may be told to straighten your position slightly after the needle is in place. 这是为了帮助测量脑脊液压力.

麻醉剂第一次注射时会刺痛或灼痛. There will be a hard pressure sensation when the needle is inserted. 经常, there is some brief discomfort when the needle goes through the tissue surrounding the spinal cord. 这种疼痛几秒钟后就会消失.

在大多数情况下，整个过程大约需要30分钟. The actual pressure measurements and CSF collection only take a few minutes.

为什么要进行测试

This test is done to measure pressures within the CSF and to collect a sample of the fluid for further testing.

脑脊液分析可用于诊断某些神经系统疾病. These may include infections (such as 脑膜炎) and brain or spinal cord damage. 脊髓穿刺也可用于诊断 正常压力脑积水 或者动脉瘤导致的脊髓液出血.

正常的结果

正常值的范围通常如下:

• 压力:70 ~ 180mm H₂O
• 外观:透明，无色
• 脑脊液总蛋白: 15 ~ 60mg / 100ml (0.15 to 0.6 g/L)
• 丙种球蛋白占3%到12% 血清总蛋白
• CSF葡萄糖: 50 ~ 80mg / 100ml或2.77 to 4.44 mmol/L(或大于血糖水平的三分之二)
• 脑脊液细胞计数: 0 to 5 white blood cells (all mononuclear), and no red blood cells
• 氯化物:110至125 mEq/L

Normal value ranges may vary slightly among different laboratories. Talk to your provider about the meaning of your specific test results.

The examples above show the common measurements for results for these tests. Some laboratories use different measurements or may test different specimens.

异常结果意味着什么

如果脑脊液看起来浑浊, it could mean there is an infection or a buildup of white blood cells or protein.

If the CSF looks bloody or red, it may be a sign of bleeding or spinal cord obstruction. 如果它是棕色的, 橙色, 或黄色, it may be a sign of increased CSF protein or previous bleeding (more than 3 days ago). There may be blood in the sample that came from the spinal tap itself. 这使得解释测试结果变得更加困难.

脑脊液压力

• 脑脊液压力升高可能是由于 颅内压增高 (颅骨内压力).
• Decreased CSF pressure may be due to spinal block, dehydration, or CSF leakage.

脑脊液蛋白

• 脑脊液蛋白升高可能是由于脑脊液中的血液， 糖尿病, polyneuritis, tumor, injury, or any inflammatory or infectious condition.
• Decreased protein is a sign of rapid CSF production or systemic loss of protein.

CSF葡萄糖

• 脑脊液葡萄糖升高是高血糖的征兆.
• 脑脊液葡萄糖降低可能是由于 低血糖症 (低血糖)，细菌或真菌感染(如 脑膜炎)、肺结核或某些其他类型的脑膜炎.

脑脊液中的血细胞

• Increased white blood cells in the CSF may be a sign of 脑膜炎, 急性 感染，长期(慢性)疾病的开始，肿瘤， 脓肿或脱髓鞘疾病(如多发性硬化症).
• Red blood cells in the CSF sample may be a sign of bleeding into the spinal fluid or the result of a traumatic lumbar puncture.

其他脑脊液结果

• Increased CSF gamma globulin levels may be due to diseases such as 多发性硬化症, 神经梅毒, or 格林-巴利综合征.

可以进行测试的附加十大赌博靠谱网络平台:

• 慢性炎性多神经病变
• 代谢引起的痴呆
• 脑炎
• 癫痫
• 热性惊厥(儿童)
• 全身性强直阵挛发作
• 脑积水
• 常压性脑积水(NPH)
• 垂体瘤
• 瑞氏综合征

风险

腰椎穿刺的风险包括:

• Bleeding into the spinal canal or around the brain (subdural hematomas).
• 测试过程中的不适.
• 测试后头痛可能持续数小时或数天. 喝咖啡等含咖啡因的饮料可能会有帮助, 茶或苏打水有助于缓解头痛. 如果头痛持续超过几天(特别是当你坐着的时候), 站立或行走)，你可能有csf泄漏. 如果发生这种情况，你应该和你的十大赌博平台排行榜谈谈.
• 对麻醉剂的过敏反应.
• 由针头穿过皮肤引起的感染.

Brain herniation may occur if this test is done on a person with a mass in the brain (such as a tumor or 脓肿). 这可能导致脑损伤或死亡. This test is not done if an exam or test reveals signs of a brain mass.

Damage to the nerves in the spinal cord may occur, particularly if the person moves during the test.

Cisternal puncture or ventricular puncture carries additional risks of brain or spinal cord damage and bleeding within the brain.

注意事项

这项测试对患有以下疾病的人更危险:

• A tumor in the back of the brain that is pressing down on the brainstem
• 血液凝固问题
• 血小板计数低(血小板减少症)
• 个人服用血液稀释剂, 阿斯匹林, 氯吡格雷, 或者其他类似的药物来减少血栓的形成.

参考文献

德卢卡GC，格里格斯RC. 神经系统疾病患者的治疗方法. 参见:Goldman L, Schafer AI主编. Goldman-Cecil医学. 26日艾德. Philadelphia, PA: Elsevier; 2020:chap 368.

Euerle BD. 脊髓穿刺及脑脊液检查. 见:Roberts JR, Custalow CB, Thomsen TW，编辑. Roberts and Hedges' Clinical Procedures in Emergency Medicine and Acute Care. 7日艾德. Philadelphia, PA: Elsevier; 2019:chap 60.

罗森博格GA. 脑水肿和脑脊液循环紊乱. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ，编辑. 布拉德利和达洛夫的《临床实践中的神经学. 8日艾德. Philadelphia, PA: Elsevier; 2022:chap 88.