Departments of Anesthesiology at the University of Michigan, Tufts, Duke University School of Medicine, Wake Forest University School of Medicine and Medical University of South Carolina, USA.
Departments of Anesthesiology at the University of Michigan, Tufts, Duke University School of Medicine, Wake Forest University School of Medicine and Medical University of South Carolina, USA.
Int J Obstet Anesth. 2023 Nov;56:103917. doi: 10.1016/j.ijoa.2023.103917. Epub 2023 Aug 3.
Research suggests that postpartum post-dural puncture headache (PDPH) might be prevented or treated by administering intravenous cosyntropin.
In this retrospective cohort study, we questioned whether prophylactic (1 mg) and therapeutic (7 µg/kg) intravenous cosyntropin following unintentional dural puncture (UDP) was effective in decreasing the incidence of PDPH and therapeutic epidural blood patch (EBP) after birth. Two tertiary-care American university hospitals collected data from November 1999 to May 2017. Two hundred and fifty-three postpartum patients who experienced an UDP were analyzed. In one institution 32 patients were exposed to and 32 patients were not given prophylactic cosyntropin; in the other institution, once PDPH developed, 36 patients were given and 153 patients were not given therapeutic cosyntropin. The primary outcome for the prophylactic cosyntropin analysis was the incidence of PDPH and for the therapeutic cosyntropin analysis in exposed vs. unexposed patients, the receipt of an EBP. The secondary outcome for the prophylactic cosyntropin groups was the receipt of an EBP.
In the prophylactic cosyntropin analysis no significant difference was found in the risk of PDPH between those exposed to cosyntropin (19/32, 59%) and unexposed patients (17/32, 53%; odds ratio (OR) 1.37, 95% CI 0.48 to 3.98, P = 0.56), or in the incidence of EBP between exposed (12/32, 38%) and unexposed patients (6/32, 19%; OR 2.6, 95% CI 0.83 to 8.13, P = 0.095). In the therapeutic cosyntropin analysis, in patients exposed to cosyntropin the incidence of EBP was significantly higher (20/36, 56% vs. 43/153, 28%; OR 3.20, 95% CI 1.52 to 6.74, P = 0.002).
Our data show no benefits from the use of cosyntropin for preventing or treating postpartum PDPH.
研究表明，在意外硬膜穿刺后（UDP）给予静脉内促皮质素可能预防或治疗产后硬膜穿刺后头痛（PDPH）。
在这项回顾性队列研究中，我们探讨了预防性（1mg）和治疗性（7μg/kg）静脉内促皮质素在 UDP 后是否能降低产后 PDPH 的发生率，并降低产后治疗性硬膜外血贴（EBP）的发生率。两家美国三级保健大学医院于 1999 年 11 月至 2017 年 5 月期间收集数据。分析了 253 例产后 UDP 患者。在一个机构中，32 例患者接受了预防性促皮质素治疗，32 例患者未接受预防性促皮质素治疗；在另一个机构中，一旦出现 PDPH，36 例患者接受了治疗性促皮质素治疗，153 例患者未接受治疗性促皮质素治疗。预防性促皮质素分析的主要结局是 PDPH 的发生率，而在暴露于和未暴露于治疗性促皮质素的患者中，EBP 的发生率是次要结局。预防性促皮质素组的次要结局是 EBP 的使用率。
在预防性促皮质素分析中，接受促皮质素治疗的患者（19/32，59%）与未接受治疗的患者（17/32，53%；比值比（OR）1.37，95%CI 0.48 至 3.98，P=0.56）、EBP 发生率（12/32，38%）与未接受治疗的患者（6/32，19%；OR 2.6，95%CI 0.83 至 8.13，P=0.095）之间，PDPH 的发生率无显著差异。在治疗性促皮质素分析中，暴露于促皮质素的患者 EBP 的发生率显著较高（20/36，56%vs. 43/153，28%；OR 3.20，95%CI 1.52 至 6.74，P=0.002）。
我们的数据表明，促皮质素在预防或治疗产后 PDPH 方面没有益处。
