Clinic for Neurology, Clinical Center of Niš, Niš, Serbia; Department for Neurology, Faculty of Medicine, University of Niš, Niš, Serbia.
Clinic for Neurology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
World Neurosurg. 2020 Jan;133:e540-e550. doi: 10.1016/j.wneu.2019.09.085. Epub 2019 Sep 25.
Post-dural puncture headache (PDPH) has been the most common complication of diagnostic and therapeutic lumbar puncture (LP). The occurrence and clinical features of PDPH in relationship to different demographic, clinical, and paraclinical parameters and parameters related to LP were assessed.
We conducted a cohort, prospective, single-center study of 252 consecutive patients (105 men and 147 women; average age, 47.3 ± 15.0 years), who had undergone LP for different medical reasons from February 2018 to June 2018 at the Clinic for Neurology Clinical Center of Serbia (Belgrade, Serbia).
Of the 252 patients, PDPH was reported in 133 (52.8%). The incidence of PDPH was more frequent in women (64.7%; P = 0.043). Univariate analyses identified the following significant risk factors for PDPH: female gender (odds ratio [OR], 1.74; 95% confidence interval [CI], 1.05-2.89), age (OR, 0.95; 95% CI, 0.94-0.97), smoking duration (OR, 0.91; 95% CI, 0.88-0.95), preexisting headaches (OR, 2.40; 95% CI, 1.39-4.17), circulatory system disease (OR, 0.52; 95% CI, 0.29-0.92), and musculoskeletal system and connective tissue disease (OR, 0.31; 95% CI, 0.12-0.81). In the multivariable model, duration of smoking and preexisting headaches remained independent risk factors for PDPH (OR, 0.93; 95% CI, 0.88-0.97; P = 0.002; and OR, 4.23; 95% CI, 1.27-14.08; P = 0.019, respectively). For various PDPH characteristics, significant risk factors were identified, including age, female gender, body mass index, circular or endocrine system diseases, and the use of caffeinated drinks before LP. In addition, the caliber of the traumatic needle, direction and number of needle stitches during LP, occurrence, intensity, and radiation of pain during LP, volume of sampled cerebrospinal fluid, rest and hydration after LP, preexisting headache, and earlier PDPH were significant. All these models were well-calibrated (Hosmer-Lemeshow test, P > 0.05).
The results of the present study are important for the prediction of the occurrence of PDPH and the differential diagnosis of headaches after LP.
腰椎穿刺（LP）后头痛（PDPH）是诊断和治疗性 LP 最常见的并发症。本研究评估了不同人口统计学、临床和实验室参数以及与 LP 相关的参数与 PDPH 发生之间的关系。
我们进行了一项前瞻性队列研究，共纳入了 252 例连续患者（105 名男性和 147 名女性；平均年龄为 47.3±15.0 岁），他们因不同的医学原因于 2018 年 2 月至 2018 年 6 月在塞尔维亚临床中心神经病学诊所（塞尔维亚贝尔格莱德）接受 LP。
252 例患者中，133 例（52.8%）报告出现 PDPH。女性中 PDPH 的发生率更高（64.7%；P=0.043）。单因素分析确定了 PDPH 的以下显著危险因素：女性（比值比 [OR]，1.74；95%置信区间 [CI]，1.05-2.89）、年龄（OR，0.95；95%CI，0.94-0.97）、吸烟时间（OR，0.91；95%CI，0.88-0.95）、既往头痛（OR，2.40；95%CI，1.39-4.17）、循环系统疾病（OR，0.52；95%CI，0.29-0.92）和肌肉骨骼系统及结缔组织疾病（OR，0.31；95%CI，0.12-0.81）。在多变量模型中，吸烟时间和既往头痛仍然是 PDPH 的独立危险因素（OR，0.93；95%CI，0.88-0.97；P=0.002；OR，4.23；95%CI，1.27-14.08；P=0.019）。对于各种 PDPH 特征，也确定了显著的危险因素，包括年龄、女性、体重指数、循环或内分泌系统疾病以及 LP 前摄入含咖啡因饮料。此外，创伤性针头的口径、LP 时针的方向和数量、LP 期间疼痛的发生、强度和放射、抽取的脑脊液量、LP 后的休息和补液、既往头痛以及更早发生的 PDPH 均具有显著意义。所有这些模型均具有良好的校准度（Hosmer-Lemeshow 检验，P＞0.05）。
本研究结果对于预测 PDPH 的发生和 LP 后头痛的鉴别诊断具有重要意义。
