School of Medicine and Pharmacology, University of Western Australia, Crawley, Australia.
Anesth Analg. 2011 Jul;113(1):126-33. doi: 10.1213/ANE.0b013e318218204d. Epub 2011 May 19.
Our aim in this multinational, multicenter, randomized, blinded trial was to determine the optimum of 3 volumes of autologous blood for an epidural blood patch.
Obstetric patients requiring epidural blood patch after unintentional dural puncture during epidural catheter insertion were allocated to receive 15, 20, or 30 mL of blood, stratified for the timing of epidural blood patch and center. Participants were followed for 5 days. The primary study end point was a composite of permanent or partial relief of headache, and secondary end points included permanent relief, partial relief, persisting headache severity, and low back pain during or after the procedure.
One hundred twenty-one women completed the study. The median (interquartile range) volume administered was 15 (15-15), 20 (20-20), and 30 (22-30) mL, with 98%, 81%, and 54% of groups 15, 20, and 30 receiving the allocated volume. Among groups 15, 20, and 30, respectively, the incidence of permanent or partial relief of headache was 61%, 73%, and 67% and that of complete relief of headache was 10%, 32%, and 26%. The 0- to 48-hour area under the curve of headache score versus time was highest in group 15. The incidence of low back pain during or after the epidural blood patch was similar among groups and was of low intensity, although group 15 had the highest postprocedural back pain scores. Serious morbidity was not reported.
Although the optimum volume of blood remains to be determined, we believe these findings support an attempt to administer 20 mL of autologous blood when treating postdural puncture headache in obstetric patients after unintentional dural puncture.
在这项多中心、随机、双盲试验中，我们的目的是确定硬膜外血贴治疗意外硬膜穿刺后头痛的最佳自体血容量。
在硬膜外导管插入过程中意外刺破硬脑膜后需要进行硬膜外血贴的产科患者，按 15、20 或 30mL 血容量进行分层，分别接受 15、20 或 30mL 血容量，然后进行硬膜外血贴治疗，并按硬膜外血贴时机和中心进行分层。对参与者进行 5 天随访。主要研究终点为头痛完全或部分缓解的复合终点，次要终点包括完全缓解、部分缓解、持续头痛严重程度和操作过程中或操作后腰背疼痛。
121 名女性完成了这项研究。中位数（四分位间距）输注量为 15（15-15）、20（20-20）和 30（22-30）mL，分别有 98%、81%和 54%的 15、20 和 30mL 组输注了分配的容量。15、20 和 30mL 组的头痛完全或部分缓解的发生率分别为 61%、73%和 67%，头痛完全缓解的发生率分别为 10%、32%和 26%。0-48 小时头痛评分的曲线下面积与时间的关系在 15mL 组最高。硬膜外血贴过程中或之后腰背疼痛的发生率在各组之间相似，且疼痛强度较低，尽管 15mL 组的术后腰背疼痛评分最高。未报告严重的发病率。
尽管最佳血容量仍有待确定，但我们认为这些发现支持在意外硬膜穿刺后产科患者发生硬膜穿刺后头痛时尝试输注 20mL 自体血。
