L'ubuský M, Berta E, Procházka M, Marek O, Kudela M
Gynekologicko-porodnická klinika LF UP a FN, Olomouc.
Cas Lek Cesk. 2006;145(3):204-8.
Paper gives the analyse of the incidence of post-dural puncture headache in patients undergoing caesarean section in spinal anaesthesia at the Department of Obstetrics and Gynecology in Olomouc in 2003-2004.
Post-dural puncture headache following caesarean section in spinal anaesthesia in 2003 was retrospectively analysed. Subsequently, measures to reduce the incidence of this complication (use of Whitacre and Atra ucan needles) were implemented. 2004 patients were followed prospectively. 54 caesarean sections - 16.3% (54/331) were performed in spinal anaesthesia in 2003. Following needles were used to establish spinal blockade: Quincke 22G - 35.2% (19/54), Quincke 25G - 50% (27/54), Atraucan 26G - 14.8% (8/54). Post-dural puncture headache occurred in 9 cases - 16.6% (9/54) (22G - 7x, 25G - 2x), the onset of symptoms occurred after 24 to 65 hours after the spinal blockade (mean 41.7). It was necessary to perform epidural blood patch (EBP) in 7 cases - 77% (7/9) - 12.9% (7/54) (22G - 5x, 25G - 2x). Epidural blood patch (EBP) was performed after 7 to 45 hours after the onset of symptoms (median 28.4). The age of patients at the time of delivery ranged between 22 to 43 years (median 34.5). 36 caesarean sections - 8.4% (36/426) were performed in spinal anaesthesia in 2004. Following needles were used to establish spinal blockade: Whitacre 27G - 63,9% (23/36), Atraucan 26G - 13,9% (5/3), Quincke 25G - 11,1 (4/36), Quincke 22G - 11,1% (4/36). Post-dural puncture headache (PDPH) occurred in 3 cases - 8.3 (3/36) (25G - 1x, 22G - 2x), the onset of symptoms occurred after 24 to 54 hours after spinal blockade (median 36.0). It was not necessary to perform epidural blood patch. The age of patients at the time of delivery ranged between 22 to 39 years (median 28.5).
Incidence of post-dural puncture headache (PDPH) is significantly higher in pregnant women and in puerperal period compared to general population. The use of appropriate needles for spinal blockade and adequate level of anaesthesiologist's skills lead to lower incidence of post-dural puncture headache (PDPH) after caesarean section performed in spinal anaesthesia.
本文对2003 - 2004年在奥洛穆茨妇产科接受脊髓麻醉剖宫产的患者中硬膜外穿刺后头痛的发生率进行了分析。
回顾性分析了2003年脊髓麻醉剖宫产术后硬膜外穿刺后头痛的情况。随后，实施了降低该并发症发生率的措施（使用Whitacre针和Atraucan针）。对2004年的患者进行了前瞻性随访。2003年，331例剖宫产中有54例（16.3%，54/331）采用脊髓麻醉。用于建立脊髓阻滞的针具如下：Quincke 22G - 35.2%（19/54），Quincke 25G - 50%（27/54），Atraucan 26G - 14.8%（8/54）。9例（16.6%，9/54）发生了硬膜外穿刺后头痛（22G - 7例，25G - 2例），症状在脊髓阻滞后24至65小时出现（平均41.7小时）。7例（77%，7/9）即12.9%（7/54）（22G - 5例，25G - 2例）需要进行硬膜外血贴治疗。硬膜外血贴在症状出现后7至45小时进行（中位时间28.4小时）。分娩时患者年龄在22至43岁之间（中位年龄34.5岁）。2004年，426例剖宫产中有36例（8.4%，36/426）采用脊髓麻醉。用于建立脊髓阻滞的针具如下：Whitacre 27G - 63.9%（23/36），Atraucan 26G - 13.9%（5/36），Quincke 25G - 11.1%（4/36），Quincke 22G - 11.1%（4/36）。3例（8.3%，3/36）（25G - 1例，22G - 2例）发生了硬膜外穿刺后头痛，症状在脊髓阻滞后24至54小时出现（中位时间36.0小时）。无需进行硬膜外血贴治疗。分娩时患者年龄在22至39岁之间（中位年龄28.5岁）。
与普通人群相比，孕妇及产褥期硬膜外穿刺后头痛（PDPH）的发生率显著更高。在脊髓麻醉下行剖宫产时，使用合适的针具进行脊髓阻滞以及麻醉医生具备足够的技能水平可降低硬膜外穿刺后头痛（PDPH）的发生率。
