Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, 4800 Sand Point Way NE MB.11.500, Seattle, WA 98105, USA.
Department of Anesthesiology, Duke University Medical Center, 3094, Durham, NC 27710, USA.
J Clin Anesth. 2017 Feb;37:77-81. doi: 10.1016/j.jclinane.2016.10.037. Epub 2017 Jan 3.
To explore how pushing during labor and body mass index affect the development of postdural puncture headache in parturients who experienced dural puncture with Tuohy needles.
Retrospective cohort.
Obstetric ward and operating rooms at a university-affiliated hospital.
One hundred ninety parturients who had witnessed dural puncture with 17 or 18 gauge Tuohy needles from 1999-2014.
Patients were categorized by pushing status and body mass index (kg/m): nonobese <30, obese 30-39.99, morbidly obese 40-49.99, and super obese ≥50.
Headache, number of days of headache, maximum headache score, and epidural blood patch placement.
Compared with women who did not push, women who pushed during labor had increased risk of postdural puncture headache (odds ratio [OR], 2.1 [1.1-4.0]; P=.02), more days of headache (P=.02), and increased epidural blood patch placement (P=.02). Super obese patients were less likely to develop headache compared with nonobese (OR, 0.33 [0.13-0.85]; P=.02), obese (OR, 0.37 [0.14-0.98]; P=.045], and morbidly obese patients (OR, 0.20 [0.05-0.68]; P<.01). In a multivariate logistic regression model, lack of pushing (OR, 0.57 [0.29-1.10]; P=.096) and super obesity (OR, 0.41 [0.16-1.02]; P=.056] were no longer significantly associated with reduced risk of postdural puncture headache.
Parturients who did not push before delivery and parturients with body mass index ≥50kg/m were less likely to develop postdural puncture headache in a univariate analysis. Similar trends were demonstrated in a multivariate model, but were no longer statistically significant.
探讨分娩时的用力推挤和体重指数（BMI）对使用 Tuohy 针行硬脊膜穿刺后产妇发生硬脊膜穿刺后头痛（PDPH）的影响。
回顾性队列研究。
大学附属医院的产科病房和手术室。
1999 年至 2014 年间，190 名见证了使用 17 或 18 号 Tuohy 针进行硬脊膜穿刺的产妇。
根据产妇的用力推挤状态和 BMI（kg/m²）进行分类：非肥胖组<30，肥胖组 30-39.99，病态肥胖组 40-49.99，超级肥胖组≥50。
头痛、头痛持续天数、头痛最大评分和硬膜外血补丁置管。
与未用力推挤的产妇相比，分娩时用力推挤的产妇发生 PDPH 的风险增加（比值比[OR]，2.1[1.1-4.0]；P=.02），头痛持续时间更长（P=.02），硬膜外血补丁置管率更高（P=.02）。与非肥胖产妇相比，超级肥胖产妇发生头痛的风险降低（OR，0.33[0.13-0.85]；P=.02），肥胖产妇（OR，0.37[0.14-0.98]；P=.045）和病态肥胖产妇（OR，0.20[0.05-0.68]；P<.01）。在多变量逻辑回归模型中，未用力推挤（OR，0.57[0.29-1.10]；P=.096）和超级肥胖（OR，0.41[0.16-1.02]；P=.056）不再与 PDPH 风险降低显著相关。
在单变量分析中，分娩前未用力推挤和 BMI≥50kg/m²的产妇发生 PDPH 的可能性较低。在多变量模型中也显示出类似的趋势，但不再具有统计学意义。
