硬膜穿刺后头痛行硬膜外血贴治疗的长期疗效：一项初步研究。
Long-Term Outcomes of Post Dural Puncture Headache Treated With Epidural Blood Patch: A Pilot Study.
机构信息
Hasoon, MD, Cai, MD, Aner, MD, Rana, MD, Simopoulos, 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. AL-Jumah, MD, Baylor College of Medicine, Department of Anesthesiology, Houston, TX. Burroughs, MD, Methodist Dallas Medical Center, Department of Surgery, Dallas, TX. 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):25-32.
BACKGROUND
Post dural puncture headache (PDPH) is a known complication which may occur in the setting of patients undergoing lumbar punctures (LP) for diagnostic or therapeutic purposes. The gold standard for treating a PDPH is an epidural blood patch (EBP). There have been few publications evaluating the long-term outcomes of PDPH treated with EBP. The aim of this pilot study was to examine the incidence of chronic headaches in dural puncture patients who received EBP versus those who did not.
METHODS
A retrospective case control study was performed at a single large center institution. Forty-nine patients who had intentional dural puncture were identified on chart review and completed a survey questionnaire via phone interview: twenty-six of these patients required a subsequent EBP, while twenty-three did not. The primary outcomes were the development and prevalence of chronic headaches after the procedures. There was no statistically significant difference in the prevalence of current headaches between the EBP group and Non-EBP group (54% vs. 52% p = 0.91). There were no significant differences in the rates of severity and descriptive qualities of headache between the EBP and non-EBP groups. There was higher incidence of tinnitus in the PDPH patients.
SUMMARY
This pilot study demonstrates that patients who received an EBP for treatment of a PDPH following LP are no more likely to experience chronic headaches compared to patients who do not receive an EBP. However, both the EBP group and Non-EBP group had high incidence of chronic headaches which may be related to dural puncture or a baseline trait of this cohort given the recall bias. There is a suggestion that tinnitus could be a long-term residual symptom of PDPH treated with EBP.
背景
腰椎穿刺（LP）后头痛（PDPH）是一种已知的并发症，可能发生在因诊断或治疗目的而行 LP 的患者中。治疗 PDPH 的金标准是硬膜外血贴（EBP）。只有少数文献评估了 EBP 治疗 PDPH 的长期结果。本初步研究的目的是检查接受 EBP 治疗的硬脊膜穿刺患者与未接受 EBP 治疗的患者慢性头痛的发生率。
方法
对单一大中心机构进行回顾性病例对照研究。通过病历回顾确定了 49 名有意进行硬脊膜穿刺的患者，并通过电话访谈完成了问卷调查：其中 26 名患者需要进行后续 EBP，而 23 名患者不需要。主要结果是在操作后慢性头痛的发生和流行情况。EBP 组和非 EBP 组的当前头痛患病率无统计学差异（54%对 52%，p=0.91）。EBP 组和非 EBP 组之间头痛的严重程度和描述性特征的发生率没有显著差异。PDPH 患者耳鸣发生率较高。
总结
本初步研究表明，与未接受 EBP 治疗的患者相比，接受 EBP 治疗 LP 后 PDPH 的患者更不易发生慢性头痛。然而，EBP 组和非 EBP 组慢性头痛的发生率都很高，这可能与硬脊膜穿刺或该队列的基线特征有关，因为存在回忆偏倚。有迹象表明，耳鸣可能是 EBP 治疗 PDPH 的长期残留症状。
Zotero 插件