Veterans Affairs Medical Center, Cincinnati, OH, USA.
Pain Physician. 2013 Jan;16(1):E25-30.
Although headache is the most common complication of dural puncture, knowledge gaps remain about patient-related risks. Data are lacking on the role, if any, of tobacco smoking, race, anxiety, depression, and Post Traumatic Stress Disorder (PTSD) in conferring risk for post-dural puncture headache (PDPH).
To determine the influence of tobacco smoking, race, anxiety,depressed mood, and PTSD on the risk for PDPH.
Retrospective chart review, single site.
We determined the incidence of significant PDPH according to age, sex, race, smoking status, and psychiatric diagnosis in 153 consecutive research patients at the Cincinnati Veterans Affairs Medical Center who had continuous cerebrospinal fluid (CFS) sampling performed after using a large-bore (17 gauge) Tuohy needle to place a 20-gauge polyamide catheter in the lumbar spinal canal.
Thirty-nine subjects (25.5%) had significant PDPH, defined as requiring an epidural blood patch for therapy (an average of 4 days post-procedure). Greater age was associated with a decreased risk of PDPH (P = 0.008); subjects over the age of 40 had the lowest incidence (15.7%). Women and men had a 31.4% and 23.7% incidence of PDPH, respectively; these were not significantly different (P = 0.38). Neither were rates of PDPH in Caucasians (28.0%) and African-Americans (15.6%) significantly different (P = 0.18) Healthy controls had a higher incidence of PDPH than patients with PTSD (P = 0.032). Smokers had a lower incidence of PDPH than non-smokers, 13.7% vs. 34.1% (P = 0.009).
This was not a prospective study, rather a retrospective chart review.
Most notably, smokers had a considerably reduced rate of PDPH in comparison with non-smokers. This information could be a useful addition to the clinical assessment of relative risk for PDPH. Further research into the mechanisms by which tobacco smoking may inhibit PDPH, such as nicotine stimulation of dopamine neurotransmission or alterations in coagulation, appears warranted.
尽管头痛是硬脑膜穿刺后最常见的并发症，但患者相关风险的知识仍存在空白。关于吸烟、种族、焦虑、抑郁和创伤后应激障碍（PTSD）在硬脊膜穿刺后头痛（PDPH）风险中的作用的数据缺乏。
确定吸烟、种族、焦虑、抑郁和 PTSD 是否会影响 PDPH 的风险。
回顾性图表审查，单站点。
我们在辛辛那提退伍军人事务医疗中心的 153 名连续接受研究的患者中，根据年龄、性别、种族、吸烟状况和精神科诊断，确定了使用大口径（17 号）Tuohy 针将 20 号聚酰胺导管放置在腰椎椎管后，使用连续脑脊髓液（CSF）采样时出现明显 PDPH 的发生率。
39 名受试者（25.5%）出现明显的 PDPH，定义为需要硬膜外血贴治疗（平均在手术后 4 天）。年龄较大与 PDPH 风险降低有关（P = 0.008）；40 岁以上的患者发生率最低（15.7%）。女性和男性的 PDPH 发生率分别为 31.4%和 23.7%；差异无统计学意义（P = 0.38）。白人和非裔美国人的 PDPH 发生率也无显著差异（P = 0.18）。健康对照组的 PDPH 发生率高于 PTSD 患者（P = 0.032）。吸烟者的 PDPH 发生率低于非吸烟者，分别为 13.7%和 34.1%（P = 0.009）。
这不是一项前瞻性研究，而是一项回顾性图表审查。
值得注意的是，与非吸烟者相比，吸烟者的 PDPH 发生率明显降低。这一信息可以为 PDPH 相对风险的临床评估提供有用的补充。进一步研究吸烟如何通过尼古丁刺激多巴胺神经传递或改变凝血机制来抑制 PDPH 的机制似乎是合理的。
