Che Xiangming, Zhang Wenyu, Xu Mingjun
Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100006, China.
Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100006, China.
J Clin Anesth. 2016 Nov;34:154-8. doi: 10.1016/j.jclinane.2016.03.066. Epub 2016 May 5.
Postdural puncture headache (PDPH) is the most common symptom of accidental dural puncture, a frequent complication of intraspinal anesthesia. We developed a postoperative intervention technique to prevent and treat PDPH in accidental dural puncture patients, including epidural pumping of saline. This retrospective study aimed to retrospectively evaluate this new technique for PDPH prevention and treatment.
Retrospective study.
Beijing Obstetrics and Gynecology Hospital affiliated to the Capital Medical University, between January 2006 and December 2012.
Eighty-seven cases undergoing intraspinal anesthesia were assessed.
Of these patients, 68 cases had successful repuncture and were assigned to group A (epidural filling group, n=68), receiving continuous epidural pumping of 0.9% NS (150mL) at a rate of 6mL/h; the remaining cases were assigned to group B (conservative therapy group, n=19).
Age, height, and body weight were collected, and postoperative headache was assessed using a visual analog scale.
Of 68 patients in group A, 49 (72.1%) developed PDPH, whereas all in group B developed PDPH (P=.009). In addition, all patients showed PDPH within 3days after surgery regardless of treatment group. However, a statistically significant difference was obtained for PDPH duration between groups A and B (P<.001). Multivariate logistic regression analysis showed that frequency of epidural puncture and continuous epidural pumping of saline were significant risk factors for PDPH.
Our data indicated that application of 6mL/h saline effectively contributes to PDPH management, and its clinical application should be broadened.
硬膜穿刺后头痛（PDPH）是意外硬膜穿刺最常见的症状，而意外硬膜穿刺是脊髓麻醉常见的并发症。我们开发了一种术后干预技术来预防和治疗意外硬膜穿刺患者的PDPH，包括硬膜外注入生理盐水。这项回顾性研究旨在回顾性评估这种预防和治疗PDPH的新技术。
回顾性研究。
首都医科大学附属北京妇产医院，2006年1月至2012年12月。
评估了87例行脊髓麻醉的患者。
这些患者中，68例再次穿刺成功，被分配到A组（硬膜外填充组，n = 68），以6mL/h的速度持续硬膜外注入0.9%生理盐水（150mL）；其余患者被分配到B组（保守治疗组，n = 19）。
收集年龄、身高和体重，并使用视觉模拟量表评估术后头痛情况。
A组68例患者中，49例（72.1%）发生PDPH，而B组所有患者均发生PDPH（P = 0.009）。此外，无论治疗组如何，所有患者均在术后3天内出现PDPH。然而，A组和B组之间PDPH持续时间存在统计学显著差异（P < 0.001）。多因素逻辑回归分析表明，硬膜外穿刺次数和持续硬膜外注入生理盐水是PDPH的显著危险因素。
我们的数据表明，以6mL/h的速度注入生理盐水可有效改善PDPH的处理，应扩大其临床应用。
