在意外硬膜穿刺部位重复进行硬膜外血贴及其神经系统并发症：一例病例报告。
Repeat epidural blood patch at the level of unintentional dural puncture and its neurologic complications: a case report.
作者信息
Iga Kentaro, Murakoshi Takeshi, Kato Airi, Kato Keiichiro, Terada Shuhei, Konno Hiroko, Irikoma Shingo, Suzuki Takashi, Matsushita Mitsuru, Toba Yoshie
机构信息
Division of Perinatology, Fetal Diagnosis and Therapy, Maternal and Perinatal Care Center, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu City, Shizuoka, Japan.
Department of Anesthesiology, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu City, Shizuoka, Japan.
出版信息
JA Clin Rep. 2019 Feb 28;5(1):14. doi: 10.1186/s40981-019-0232-3.
BACKGROUND
Autologous epidural blood patch (AEBP) is effective for post-dural-puncture headache (PDPH). In some cases, repeat procedures are required for complete cure. In rare instances, severe adverse effects can occur. We present a case of neurologically complicated AEBPs, one of which was performed at the interspace of unintentional dural puncture (UDP).
CASE PRESENTATION
A 40-year-old primigravida sustained UDP at the L2-3 interspace during combined spinal-epidural anesthesia for a scheduled cesarean section. She developed PDPH and underwent a single AEBP at L3-4. The PDPH recurred and she required another AEBP at L2-3, after which she reported radicular pains. A diagnosis of subdural hematoma and adhesive arachnoiditis was made. Her symptoms partially resolved in the following months.
CONCLUSION
It may be prudent to reconsider the use of repeated AEBP and to avoid the interspace of UDP. A thorough evaluation is warranted to exclude treatable lesions when adverse effects occur.
背景
自体硬膜外血补丁（AEBP）对硬膜穿刺后头痛（PDPH）有效。在某些情况下，需要重复操作才能完全治愈。在极少数情况下，可能会出现严重不良反应。我们报告一例神经并发症的AEBP病例，其中一次是在无意硬膜穿刺（UDP）间隙进行的。
病例报告
一名40岁初产妇在择期剖宫产的腰麻-硬膜外联合麻醉期间，L2-3间隙发生UDP。她出现PDPH，并在L3-4进行了单次AEBP。PDPH复发，她需要在L2-3再次进行AEBP，之后她报告有神经根性疼痛。诊断为硬膜下血肿和粘连性蛛网膜炎。在接下来的几个月里，她的症状部分缓解。
结论
重新考虑重复使用AEBP并避免在UDP间隙操作可能是谨慎的做法。当出现不良反应时，有必要进行全面评估以排除可治疗的病变。
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