硬膜外血补丁治疗后头痛复发的危险因素：一项回顾性队列研究。

Risk factors for recurrence of post-dural puncture headache following an epidural blood patch: a retrospective cohort study.

机构信息

Division of Anaesthesia, Department of Anaesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.

Division of Anaesthesia, Department of Anaesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland; Health Services Management and Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, Melbourne, Victoria, Australia.

出版信息

Int J Obstet Anesth. 2023 Nov;56:103925. doi: 10.1016/j.ijoa.2023.103925. Epub 2023 Sep 15.

DOI:10.1016/j.ijoa.2023.103925

PMID:37832391

Abstract

INTRODUCTION

Post-dural puncture headache (PDPH) occurs in 0.38-6.3% of neuraxial procedures in obstetrics. Epidural blood patch (EBP) is the standard treatment but fails to provide full symptom relief in 4-29% of cases. Knowledge of the risk factors for EBP failure is limited and controversial. This study aimed to identify these risk factors.

METHODS

We performed a retrospective cohort study using electronic records of 47920 patients who underwent a neuraxial procedure between 2001 and 2018 in a large maternity hospital in Switzerland. The absence of full symptom relief and the need for further treatment was defined as an EBP failure. We performed univariate and multivariate analyses to compare patients with a successful or failed EBP.

RESULTS

We identified 212 patients requiring an EBP. Of these, 55 (25.9%) had a failed EBP. Signs and symptoms of PDPH did not differ between groups. While needle size and multiple pregnancies were risk factors in the univariate analysis, mostly those related to the performance of the EBP remained significant following adjustment. The risk of failure increased when the epidural space was deeper than 5.5 cm (OR 3.08, 95% CI 1.26 to 7.49) and decreased when the time interval between the initial dural puncture and the EBP was >48 h (OR 0.20, 95% CI 0.05 to 0.83).

CONCLUSION

Persistence of PDPH following a first EBP is not unusual. Close attention should be given to patients having their EBP performed <48 h following injury and having an epidural space located >5.5 cm depth, as these factors are associated with a failed EBP.

摘要

引言

在产科的椎管内操作中，0.38-6.3%的患者会发生硬脊膜穿破后头痛（PDPH）。硬膜外血贴（EBP）是标准治疗方法，但仍有 4-29%的患者无法完全缓解症状。EBP 失败的相关风险因素知之甚少且存在争议。本研究旨在确定这些风险因素。

方法

我们对瑞士一家大型妇产医院在 2001 年至 2018 年间进行的 47920 例椎管内操作患者的电子病历进行了回顾性队列研究。将完全缓解症状和需要进一步治疗定义为 EBP 失败。我们进行了单因素和多因素分析，以比较 EBP 成功和失败的患者。

结果

我们共发现 212 例需要 EBP 的患者，其中 55 例（25.9%）EBP 失败。头痛的体征和症状在两组之间无差异。虽然在单因素分析中，针的大小和多胎妊娠是危险因素，但在调整后，与 EBP 实施相关的因素仍然具有显著意义。当硬膜外腔深度超过 5.5cm 时（OR 3.08，95%CI 1.26-7.49），失败风险增加，当初次硬脊膜穿破与 EBP 之间的时间间隔>48 小时时（OR 0.20，95%CI 0.05-0.83），失败风险降低。