Candido Kenneth D, Stevens Rom A
Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
Best Pract Res Clin Anaesthesiol. 2003 Sep;17(3):451-69. doi: 10.1016/s1521-6896(03)00033-8.
Post-dural puncture headache (PDPHA) has been a vexing problem for patients undergoing dural puncture for spinal anaesthesia, as a complication of epidural anaesthesia, and after diagnostic lumbar puncture since Bier reported the first case in 1898. This Chapter discusses the pathophysiology of low-pressure headache resulting from leakage of cerebrospinal fluid (CSF) from the subarachnoid to the epidural spaces. Clinical and laboratory research over the last 30 years has shown that use of small-gauge needles, particularly of the pencil-point design, is associated with a lower risk of PDPHA than traditional cutting point needle tips (Quincke-point needles). A careful history can rule out other causes of headache. A positional component of headache is the sine qua non of PDPHA. In high-risk patients (e.g. age < 50 years, post-partum, large-gauge-needle puncture), patients should be offered early (within 24-48 h of dural puncture) epidural blood patch. The optimum volume of blood has been shown to be 12-20 ml for adult patients. Complications of autologous epidural blood patch are rare.
自1898年比尔报告首例病例以来，硬膜穿刺后头痛（PDPHA）一直是接受脊髓麻醉硬膜穿刺、作为硬膜外麻醉并发症以及诊断性腰椎穿刺后的患者面临的一个棘手问题。本章讨论了脑脊液（CSF）从蛛网膜下腔漏至硬膜外间隙导致的低压性头痛的病理生理学。过去30年的临床和实验室研究表明，与传统的切割针尖（奎克针）相比，使用小口径针，尤其是铅笔尖设计的针，发生PDPHA的风险较低。详细的病史询问可以排除其他头痛原因。头痛的体位相关性是PDPHA的必要条件。对于高危患者（如年龄<50岁、产后、大口径针穿刺），应在硬膜穿刺后早期（24 - 48小时内）为患者实施硬膜外血贴疗法。已证明成年患者的最佳血量为12 - 20毫升。自体硬膜外血贴疗法的并发症很少见。
