硬膜外血贴并不会导致腰椎穿刺患者慢性腰痛的发展：一项初步研究。
Epidural Blood Patch does not Contribute to the Development of Chronic Low Back Pain in Patients who Undergo Lumbar Punctures: A Pilot Study.
机构信息
Hasoon, MD, Cai, MD, Aner, MD, Yazdi, MD, Simopoulos, MD, Hess, MD, Gill, MD, Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA. Urits, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA. Burroughs, MD, Methodist Dallas Medical Center, Department of Surgery, Dallas, TX. Orhurhu, MD, MPH, Massachusetts General Hospital, Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA. Viswanath, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ; University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE. Kaye, MD, PhD, Departments of Anesthesiology and Pharmacology, Toxicology and Neurosciences, Louisiana State University School of Medicine, Shreveport, LA.
出版信息
Psychopharmacol Bull. 2020 Oct 15;50(4 Suppl 1):17-24.
PURPOSE OF REVIEW
Post dural puncture headache (PDPH) is a known and relatively common complication which may occur in the setting of patients undergoing lumbar punctures (LP) for diagnostic or therapeutic purposes, and is commonly treated with an epidural blood patch (EBP). There have been few publications regarding the long-term safety of EBP for the treatment of PDPH.
RECENT FINDINGS
The aim of this pilot study was to examine any association of chronic low back pain (LBP) in patients who experienced a PDPH following a LP, and were treated with an EBP. A total of 49 patients were contacted and completed a survey questionnaire via telephone. There was no increased risk of chronic LBP in the dural puncture group receiving EBP (percentage difference 1% [95% CI -25% - 26%], RR: 0.98 [95% CI 0.49 - 1.99]) compared to the dural puncture group not receiving EBP. There were no significant differences in the severity and descriptive qualities of pain between the EBP and non-EBP groups. Both groups had higher prevalence of back pain compared to baseline.
SUMMARY
Our findings suggest that dural puncture patients undergoing EBP do not experience low back pain with increased frequency compared to dural puncture patients not undergoing EBP. Higher prevalence of LBP compared to baseline and compared to general population was seen in both groups. However, this pilot study is limited by a small sample size and no definitive conclusion can be drawn from this observation. The findings of this study should spur further prospective research into identifying potential associations between LP, EBP and chronic low back pain.
目的综述
腰椎穿刺（LP）后发生的硬脊膜穿刺后头痛（PDPH）是一种已知的、相对常见的并发症，可发生于接受 LP 以进行诊断或治疗的患者中，通常采用硬膜外血贴（EBP）治疗。关于 EBP 治疗 PDPH 的长期安全性的文献报道较少。
最近的发现
本研究旨在探讨 LP 后发生 PDPH 并接受 EBP 治疗的患者中，慢性下腰痛（LBP）的长期风险。共联系了 49 例患者，并通过电话完成了问卷调查。与未接受 EBP 的硬脊膜穿刺组相比，接受 EBP 的硬脊膜穿刺组的慢性 LBP 风险没有增加（差异百分比为 1%[95%CI-25%-26%]，RR：0.98[95%CI0.49-1.99]）。EBP 组和非 EBP 组之间疼痛的严重程度和描述性特征没有显著差异。两组的腰痛发生率均高于基线。
总结
我们的研究结果表明，与未接受 EBP 的硬脊膜穿刺组相比，接受 EBP 的硬脊膜穿刺患者发生腰痛的频率没有增加。与基线相比，两组的 LBP 发生率均较高，与一般人群相比也较高。然而，本研究受到样本量小的限制，因此不能从这一观察结果得出明确的结论。这项研究的结果应促使进一步开展前瞻性研究，以确定 LP、EBP 和慢性下腰痛之间的潜在关联。
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