From the Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York.
Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York.
Anesth Analg. 2019 Nov;129(5):1328-1336. doi: 10.1213/ANE.0000000000004336.
Increased risks of cerebral venous thrombosis or subdural hematoma, bacterial meningitis, persistent headache, and persistent low back pain are suggested in obstetric patients with postdural puncture headache (PDPH). Acute postpartum pain such as PDPH may also lead to postpartum depression. This study tested the hypothesis that PDPH in obstetric patients is associated with significantly increased postpartum risks of major neurologic and other maternal complications.
This retrospective cohort study consisted of 1,003,803 women who received neuraxial anesthesia for childbirth in New York State hospitals between January 2005 and September 2014. The primary outcome was the composite of cerebral venous thrombosis and subdural hematoma. The 4 secondary outcomes were bacterial meningitis, depression, headache, and low back pain. PDPH and complications were identified during the delivery hospitalization and up to 1 year postdelivery. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated using the inverse probability of treatment weighting approach.
Of the women studied, 4808 (0.48%; 95% CI, 0.47-0.49) developed PDPH, including 264 cases (5.2%) identified during a readmission with a median time to readmission of 4 days. The incidence of cerebral venous thrombosis and subdural hematoma was significantly higher in women with PDPH than in women without PDPH (3.12 per 1000 neuraxial or 1:320 vs 0.16 per 1000 or 1:6250, respectively; P < .001). The incidence of the 4 secondary outcomes was also significantly higher in women with PDPH than in women without PDPH. The aORs associated with PDPH were 19.0 (95% CI, 11.2-32.1) for the composite of cerebral venous thrombosis and subdural hematoma, 39.7 (95% CI, 13.6-115.5) for bacterial meningitis, 1.9 (95% CI, 1.4-2.6) for depression, 7.7 (95% CI, 6.5-9.0) for headache, and 4.6 (95% CI, 3.3-6.3) for low back pain. Seventy percent of cerebral venous thrombosis and subdural hematoma were identified during a readmission with a median time to readmission of 5 days.
PDPH is associated with substantially increased postpartum risks of major neurologic and other maternal complications, underscoring the importance of early recognition and treatment of anesthesia-related complications in obstetrics.
硬膜穿刺后头痛（PDPH）会增加产妇发生脑静脉血栓或硬膜下血肿、细菌性脑膜炎、持续性头痛和持续性腰痛的风险。分娩后的急性疼痛，如 PDPH，也可能导致产后抑郁。本研究旨在验证 PDPH 与产妇发生重大神经和其他产妇并发症的风险显著增加相关的假设。
这是一项回顾性队列研究，纳入了 2005 年 1 月至 2014 年 9 月期间在纽约州医院接受分娩时脊麻的 1003803 名女性。主要结局是脑静脉血栓和硬膜下血肿的复合结局。4 个次要结局是细菌性脑膜炎、抑郁、头痛和腰痛。PDPH 和并发症在分娩住院期间和分娩后 1 年内被识别。采用逆概率治疗加权法估计调整后的优势比（aOR）和 95%置信区间（CI）。
研究中 4808 名（0.48%；95%CI，0.47-0.49）女性发生 PDPH，其中 264 例（5.2%）在中位时间为 4 天的再次入院时被诊断。PDPH 女性的脑静脉血栓和硬膜下血肿发生率明显高于无 PDPH 女性（每 1000 次脊麻分别为 3.12 例和 1:320 例 vs 0.16 例和 1:6250 例；P<0.001）。PDPH 女性的 4 个次要结局发生率也明显高于无 PDPH 女性。与 PDPH 相关的 aOR 为脑静脉血栓和硬膜下血肿复合结局 19.0（95%CI，11.2-32.1），细菌性脑膜炎 39.7（95%CI，13.6-115.5），抑郁 1.9（95%CI，1.4-2.6），头痛 7.7（95%CI，6.5-9.0），腰痛 4.6（95%CI，3.3-6.3）。70%的脑静脉血栓和硬膜下血肿是在中位时间为 5 天的再次入院时被诊断的。
PDPH 与产妇产后发生重大神经和其他产妇并发症的风险显著增加相关，突出了早期识别和治疗产科麻醉相关并发症的重要性。
