Makito Kanako, Matsui Hiroki, Fushimi Kiyohide, Yasunaga Hideo
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
Department of Health Policy and Informatics, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
Anaesth Intensive Care. 2020 Sep;48(5):381-388. doi: 10.1177/0310057X20949555. Epub 2020 Oct 6.
The reported incidence of post--dural puncture headache (PDPH) after neuraxial anaesthesia varies widely, depending on patient and procedural risk factors. Most previous studies have had small sample sizes and focused on obstetric patients. This study aimed to investigate the incidence of PDPH and factors associated with PDPH in non-obstetric and obstetric patients after neuraxial anaesthesia. We identified patients who underwent surgery with neuraxial anaesthesia between July 2010 and December 2017 from a Japanese nationwide inpatient administrative claims and discharge database. Factors associated with PDPH (body mass index (BMI), depression, spinal abnormalities, academic hospital and location of epidural anaesthesia) were examined using multivariable logistic analyses. The incidence of PDPH in non-obstetric patients after spinal anaesthesia, epidural anaesthesia and combined spinal epidural anaesthesia was 0.16%, 0.13% and 0.23% and in obstetric patients was 1.16%, 0.99% and 1.05%, respectively. Higher BMI was associated with decreased incidence of PDPH in non-obstetric patients receiving spinal anaesthesia and obstetric patients receiving epidural anaesthesia. In female patients receiving spinal anaesthesia, a history of depression was associated with increased incidence of PDPH. Being in an academic hospital was associated with decreased incidence of PDPH in male patients receiving spinal anaesthesia and female patients receiving spinal or epidural anaesthesia, but increased incidence of PDPH in male patients receiving epidural anaesthesia. Lumbar epidural anaesthesia was associated with increased incidence of PDPH in male patients, but decreased incidence of PDPH in obstetric patients compared with thoracic epidural anaesthesia. The present study identified several potential new risk factors for PDPH, and revealed that the incidence of PDPH in non-obstetric patients after neuraxial anaesthesia was lower than in obstetric patients.
据报道，椎管内麻醉后发生硬膜穿刺后头痛（PDPH）的发生率差异很大，这取决于患者和手术风险因素。以前的大多数研究样本量较小，且主要关注产科患者。本研究旨在调查非产科和产科患者在椎管内麻醉后PDPH的发生率及与之相关的因素。我们从日本全国住院患者管理索赔和出院数据库中，识别出2010年7月至2017年12月期间接受椎管内麻醉手术的患者。使用多变量逻辑分析检查与PDPH相关的因素（体重指数（BMI）、抑郁症、脊柱异常、教学医院和硬膜外麻醉部位）。脊髓麻醉、硬膜外麻醉和腰麻-硬膜外联合麻醉后，非产科患者PDPH的发生率分别为0.16%、0.13%和0.23%，产科患者分别为1.16%、0.99%和1.05%。较高的BMI与接受脊髓麻醉的非产科患者及接受硬膜外麻醉的产科患者PDPH发生率降低相关。在接受脊髓麻醉的女性患者中，抑郁症病史与PDPH发生率增加相关。在接受脊髓麻醉的男性患者以及接受脊髓或硬膜外麻醉的女性患者中，在教学医院与PDPH发生率降低相关，但在接受硬膜外麻醉的男性患者中PDPH发生率增加。与胸段硬膜外麻醉相比，腰段硬膜外麻醉与男性患者PDPH发生率增加相关，但与产科患者PDPH发生率降低相关。本研究确定了几个PDPH潜在的新风险因素，并表明非产科患者在椎管内麻醉后PDPH的发生率低于产科患者。
