Kim Seong Hoon, Kim Tae Won, Shin Hae Eun, Lee Si Baek, Ryu Dong Woo, Park Jeong Wook
Department of Neurology, College of Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, South Korea.
Department of Neurology, College of Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, South Korea.
Front Neurol. 2019 Jul 2;10:700. doi: 10.3389/fneur.2019.00700. eCollection 2019.
Post-dural puncture headache (PDPH) is an unfavorable situation seen in considerable number of patients even though atraumatic and small needle reduces its incidence. CSF pressures measured at the time of puncture change after CSF drainage. In the present study, we investigated relationships between CSF pressure-related factors and occurrence of PDPH. We prospectively enrolled 103 participants who underwent CSF studies for meningitis. Using a standardized protocol, CSF opening pressure (OP) and closing pressure (CP) were measured, and cerebrospinal elastance (ECS) and pressure-volume index (PVI) were investigated. Within 14 days after dural puncture, we confirmed PDPH. According to PDPH development, the CSF pressure factors and clinical variables were compared between PDPH and non-PDPH group. Of the 103 participants, 100 (97.0%) had decreased CP, 16 (15.5%) had values below 6 cmHO and the pressure change after dural puncture (OP-CP) was 6.1 ± 3.1 cmHO. PVI and ECS measured by CSF drainage were 99.8 ± 89.5 and 0.4 ± 0.2 cmHO/mL. Among the demographic factors, body weight was correlated with OP ( = 0.27), CP ( = 0.35), and PVI ( = 0.20). Height was weakly correlated with CP ( = 0.199) During the study period, 22 participants (21.34%) developed PDPH. None of the CSF pressure factors were significantly different between the PDPH and non-PDPH group and did not contributed to the development of PDPH. CSF pressure factors might not be related to the development of PDPH.
硬膜穿刺后头痛（PDPH）是相当一部分患者中出现的不良情况，尽管采用无创伤小针头可降低其发生率。穿刺时测量的脑脊液压力在脑脊液引流后会发生变化。在本研究中，我们调查了脑脊液压力相关因素与PDPH发生之间的关系。我们前瞻性纳入了103名因脑膜炎接受脑脊液检查的参与者。采用标准化方案，测量脑脊液初压（OP）和终压（CP），并研究脑脊液弹性（ECS）和压力-容积指数（PVI）。在硬膜穿刺后14天内，我们确认是否发生PDPH。根据PDPH的发生情况，比较PDPH组和非PDPH组之间的脑脊液压力因素和临床变量。103名参与者中，100名（97.0%）终压降低，16名（15.5%）低于6 cmH₂O，硬膜穿刺后的压力变化（OP - CP）为6.1±3.1 cmH₂O。经脑脊液引流测量的PVI和ECS分别为99.8±89.5和0.4±0.2 cmH₂O/mL。在人口统计学因素中，体重与OP（r = 0.27）、CP（r = 0.35）和PVI（r = 0.20）相关。身高与CP弱相关（r = 0.199）。在研究期间，22名参与者（21.34%）发生了PDPH。PDPH组和非PDPH组之间的脑脊液压力因素均无显著差异，且对PDPH的发生无影响。脑脊液压力因素可能与PDPH的发生无关。
