Department of Neurology, Sir Run Run Shaw Hospital, Affiliated with School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China.
Department of Neurology, Shaoxing University Affiliated Hospital, Shaoxing, Zhejiang, People's Republic of China.
Pain Physician. 2023 Jul;26(4):383-391.
Subdural hematoma (SDH) is a potentially life-threatening complication in patients with spontaneous intracranial hypotension (SIH). Though bed rest is the basis of conservative treatment, no clear evidence exists regarding the association between bed rest and the later complication of SDH in these patients.
This study aimed to evaluate the association between bed rest and SDH development in patients with SIH.
A retrospective study was conducted from March 2013 through December 2019. Four hundred twenty adult patients diagnosed with SIH were enrolled. Clinical presentations and radiographic findings were recorded. The cumulative duration of bed rest in hours was used to measure the bed rest length. The clinical outcomes during follow-up were assessed.
Categorical data were compared using chi-square tests; continuous data were compared using the Mann-Whitney U test or Kruskal-Wallis test. A backwards stepwise Cox proportional hazard regression model adjusted with confounders which differed between SDH and non-SDH in univariate analysis was used to estimate the risk of cumulative duration of bed rest for SDH. A stratified Cox regression was performed to exclude the effect of the treatment algorithm.
Of the 420 patients with SIH, 88 (21%) were in the SDH Group and 332 (79%) were in the non-SDH (NSDH) Group. The cumulative duration of bed rest in hours was a protective factor for SDH in SIH (Hazard Ratio [HR] = 0.997; P < 0.001). A stratified Cox regression analysis showed that the cumulative duration of bed rest remained a protective factor for SDH both in patients who received conservative treatment before admission (HR = 0.997; P < 0.001) and in those who did not (HR = 0.996; P = 0.061). Age (HR = 1.029, 95% CI, 1.009-1.050; P = 0.004) and orthostatic headache (HR = 4.770, 95% 95% CI, 2.177-10.450; P < 0.001) were risk factors for SDH in SIH. The clinical outcomes, including length of hospital stay, epidural blood patch (EBP) therapy, and repeated EBP therapy, were higher in the SDH Group. The revisit rate was similar between the 2 groups.
Retrospective studies are susceptible to different radiological procedures and therapeutic strategies. A bed rest score based on a patient's memory is susceptible to recognition and reporting bias. This is a single-center study and the sample size is not large. The validity of the bed rest scale has not been previously evaluated in any other study.
Bed rest was a protective factor for SDH in patients with SIH. With more time and proper treatment, patients with SIH who have an SDH can achieve good prognosis in the long term.
在自发性颅内低血压（SIH）患者中，硬膜下血肿（SDH）是一种潜在危及生命的并发症。尽管卧床休息是保守治疗的基础，但对于卧床休息与这些患者中 SDH 后期并发症之间的关联，尚无明确证据。
本研究旨在评估 SIH 患者卧床休息与 SDH 发展之间的关系。
这是一项从 2013 年 3 月至 2019 年 12 月进行的回顾性研究。共纳入 420 例成人 SIH 患者。记录临床表现和影像学发现。使用卧床休息时间的累计小时数来衡量卧床休息时间。评估随访期间的临床结局。
使用卡方检验比较分类数据；使用 Mann-Whitney U 检验或 Kruskal-Wallis 检验比较连续数据。使用单变量分析中 SDH 和非 SDH 之间存在差异的混杂因素进行向后逐步 Cox 比例风险回归模型估计 SDH 卧床休息累计时间的风险。进行分层 Cox 回归以排除治疗方案的影响。
在 420 例 SIH 患者中，88 例（21%）为 SDH 组，332 例（79%）为非 SDH（非 SDH）组。卧床休息时间的累计小时数是 SIH 中 SDH 的保护因素（风险比[HR] = 0.997；P < 0.001）。分层 Cox 回归分析表明，在入院前接受保守治疗的患者（HR = 0.997；P < 0.001）和未接受治疗的患者（HR = 0.996；P = 0.061）中，卧床休息时间的累计小时数仍然是 SDH 的保护因素。年龄（HR = 1.029，95%CI，1.009-1.050；P = 0.004）和直立性头痛（HR = 4.770，95%CI，2.177-10.450；P < 0.001）是 SIH 中 SDH 的危险因素。SDH 组的临床结局，包括住院时间、硬膜外血贴（EBP）治疗和重复 EBP 治疗，均较高。两组的复诊率相似。
回顾性研究易受不同的影像学程序和治疗策略的影响。基于患者记忆的卧床休息评分易受认知和报告偏倚的影响。这是一项单中心研究，样本量不大。以前的任何研究都没有评估过卧床休息量表的有效性。
卧床休息是 SIH 患者 SDH 的保护因素。随着时间的推移和适当的治疗，患有 SIH 的 SDH 患者可以在长期内获得良好的预后。
