Hess J H
AANA J. 1991 Dec;59(6):549-55.
This is a review of literature from 1943 to mid-1989 on the postdural puncture headache. The article looks at the currently held thoughts on the cause, prevention, and treatments of this second most frequent side effect of spinal anesthesia. Postdural puncture headache (PDPH) is caused by vascular distension within the nondistensible cranium following the leakage of cerebral spinal fluid (CSF) into the epidural space. Prevention of PDPH can be accomplished by using small-gauge needles and possibly by using the lateral approach, as opposed to the midline approach. Luck plays a big part, because if the needle punctures a thicker portion of the dura, there is a reduced chance of PDPH. Epidural saline injection is effective only if it is used as a continuous infusion for 24 hours. The usefulness of caffeine sodium benzoate with a 70-80% success rate and epidural blood patching with a 90%-plus success rate are discussed.
这是一篇对1943年至1989年年中关于硬膜穿刺后头痛的文献综述。本文探讨了目前对于这种脊髓麻醉第二常见副作用的病因、预防和治疗的看法。硬膜穿刺后头痛（PDPH）是由于脑脊液（CSF）漏入硬膜外间隙后，不可扩张的颅骨内血管扩张所致。预防PDPH可通过使用细针，可能还可通过采用侧入路而非正中入路来实现。运气起很大作用，因为如果穿刺针穿刺到较厚的硬脑膜部分，发生PDPH的几率就会降低。硬膜外注射生理盐水仅在持续输注24小时时才有效。文中讨论了成功率为70%-80%的苯甲酸钠咖啡因以及成功率超过90%的硬膜外血贴疗法的有效性。
