硬膜穿刺后头痛
Postdural puncture headache.
作者信息
Ghaleb Ahmed
机构信息
Department of Anesthesiology, University of Arkansas for Medical Sciences, 4301 West Markham, Slot 515, Little Rock, AR 72205, USA.
出版信息
Anesthesiol Res Pract. 2010;2010. doi: 10.1155/2010/102967. Epub 2010 Aug 11.
Abstract
Postdural puncture headache (PDPH) has been a problem for patients, following dural puncture, since August Bier reported the first case in 1898. His paper discussed the pathophysiology of low-pressure headache resulting from leakage of cerebrospinal fluid (CSF) from the subarachnoid to the epidural space. 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 PDPH than traditional cutting point needle tips (Quincke-point needle). A careful history can rule out other causes of headache. A postural component of headache is the sine qua non of PDPH. In high-risk patients , for example, age < 50 years, postpartum, large-gauge needle puncture, epidural blood patch should be performed within 24-48 h of dural puncture. The optimum volume of blood has been shown to be 12-20 mL for adult patients. Complications of AEBP are rare.
摘要
自1898年奥古斯特·比尔报告首例病例以来，硬膜穿刺后头痛（PDPH）一直是硬膜穿刺后患者面临的一个问题。他的论文讨论了脑脊液（CSF）从蛛网膜下腔漏至硬膜外腔导致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，使用小口径针头，尤其是铅笔尖设计的针头，与传统切割尖针头（奎克尖针头）相比，发生PDPH的风险更低。详细的病史可排除其他头痛原因。头痛的体位因素是PDPH的必要条件。例如，对于年龄<50岁、产后、使用大口径针头穿刺等高危患者，应在硬膜穿刺后24 - 48小时内进行硬膜外血贴疗法。已证明成年患者的最佳血量为12 - 20毫升。硬膜外血贴疗法的并发症很少见。
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