与产科意外硬脊膜穿刺后硬膜外血贴失败相关的因素：一项前瞻性、多中心、国际队列研究。
Factors associated with failed epidural blood patch after accidental dural puncture in obstetrics: a prospective, multicentre, international cohort study.
机构信息
Department of Perioperative Medicine and Intensive Care and Institution of Physiology and Pharmacology, Karolinska Hospital and Karolinska Institutet, Stockholm, Sweden.
Department of Cardiovascular Sciences, KZ Leuven, Belgium; Department of Anesthesiology, UZ Leuven, Leuven, Belgium.
出版信息
Br J Anaesth. 2022 Nov;129(5):758-766. doi: 10.1016/j.bja.2022.06.040. Epub 2022 Sep 3.
BACKGROUND
Epidural blood patch is commonly used for management of post-dural puncture headache after accidental dural puncture. The primary aim was to determine factors associated with failed epidural blood patch.
METHODS
In this prospective, multicentre, international cohort study, parturients ≥18 yr receiving an epidural blood patch for treatment of post-dural puncture headache were included. Failed epidural blood patch was defined as headache intensity numeric rating scale (NRS) score ≥7 in the upright position at 4, 24, or 48 h, or the need for a second epidural blood patch, and complete success by NRS=0 at 0-48 h after epidural blood patch. All others were considered partial success. Multinominal logistic regression was used for statistical analyses with P<0.01 considered statistically significant.
RESULTS
In all, 643 women received an epidural blood patch. Complete data to classify failure were available in 591 (91.9%) women. Failed epidural blood patch occurred in 167 (28.3%) patients; 195 (33.0%) were completely successful and 229 (38.7%) partially successful. A total of 126 women (19.8%) received a second epidural blood patch. A statistically significant association with failure was observed in patients with a history of migraine, when the accidental dural puncture occurred between lumbar levels L1/L3 compared with L3/L5 and when epidural blood patch was performed <48 h compared with ≥48 h after accidental dural puncture. In patients having radiological investigations, three intracranial bleeds were diagnosed.
CONCLUSIONS
Failed epidural blood patch occurred in 28.3% of women. Independent modifiable factors associated with failure were higher lumbar level of accidental dural puncture and short interval between accidental dural puncture and epidural blood patch. A history of migraine was associated with a higher risk of second epidural blood patch.
CLINICAL TRIAL REGISTRATION
NCT02362828.
背景
硬膜外血贴常用于治疗意外刺破硬脑膜后出现的穿刺后头痛。本研究旨在确定与硬膜外血贴失败相关的因素。
方法
这是一项前瞻性、多中心、国际队列研究，纳入了≥18 岁因穿刺后头痛接受硬膜外血贴治疗的产妇。硬膜外血贴失败定义为：4、24 或 48 小时时，直立位头痛强度数字评分量表（NRS）评分≥7，或需要第二次硬膜外血贴；硬膜外血贴后 0-48 小时 NRS 评分=0 为完全成功，其他均为部分成功。采用多项逻辑回归进行统计学分析，P<0.01 为差异有统计学意义。
结果
共 643 例女性接受了硬膜外血贴。591 例（91.9%）女性有完整的数据来分类失败。167 例（28.3%）患者发生硬膜外血贴失败；195 例（33.0%）完全成功，229 例（38.7%）部分成功。共有 126 例（19.8%）女性接受了第二次硬膜外血贴。与失败相关的统计学显著因素为：有偏头痛病史、意外刺破硬脑膜时的腰椎水平位于 L1/L3 与 L3/L5 之间、硬膜外血贴与意外刺破硬脑膜的间隔时间<48 小时。在接受影像学检查的患者中，诊断出 3 例颅内出血。
结论
28.3%的女性发生了硬膜外血贴失败。与失败相关的独立可修改因素为较高的意外刺破硬脑膜的腰椎水平和意外刺破硬脑膜与硬膜外血贴之间的较短间隔。偏头痛病史与需要第二次硬膜外血贴的风险增加相关。
临床试验注册
NCT02362828。
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