Okell R W, Sprigge J S
Park Hospital, Upton, Wirral, Merseyside.
Anaesthesia. 1987 Oct;42(10):1110-3. doi: 10.1111/j.1365-2044.1987.tb05181.x.
A survey of the recognition and management of 21 unintentional dural punctures that occurred in a series of 3500 obstetric epidurals is presented. In seven cases, dural puncture was not recognised at the time of occurrence and two patients may have subsequently received mixed epidural and subarachnoid analgesia. In two patients with dural puncture in whom air had been used to locate the epidural space, cerebrospinal fluid did not drip from the hub of the needle. A test dose did not reveal incorrect catheter placement in seven patients. The provision of an epidural infusion of Hartmann's solution for 24 hours, together with bed rest, appeared to delay the onset of dural puncture headache rather than prevent it entirely. Blood patching was required only in five of the 21 patients but was entirely successful. The implications of these observations in relationship to obstetric epidural practice are discussed.
本文介绍了对3500例产科硬膜外麻醉中发生的21例意外硬膜穿破的识别与处理情况。7例硬膜穿破发生时未被识别，2例患者随后可能接受了硬膜外和蛛网膜下腔混合镇痛。2例硬膜穿破且曾使用空气定位硬膜外间隙的患者，脑脊液未从针座滴出。7例患者的试验剂量未显示导管置入错误。给予24小时的哈特曼溶液硬膜外输注并卧床休息，似乎只能延迟而非完全预防硬膜穿破后头痛的发生。21例患者中仅5例需要进行血液填充，且全部成功。文中讨论了这些观察结果对产科硬膜外麻醉实践的影响。
