Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea.
Department of Anesthesia and Pain Medicine and Biomedical Research Institute Pusan National University Hospital, Pusan, South Korea.
J Clin Neurosci. 2024 May;123:118-122. doi: 10.1016/j.jocn.2024.03.029. Epub 2024 Apr 2.
Epidural blood patch (EBP)-the most effective treatment for intracranial hypotension (IH)-can be performed using the blind technique in the lateral position or under fluoroscopic guidance in the prone position. This study aimed to compare the effectiveness of EBP in patients with spontaneous intracranial hypotension (sIH) and iatrogenic intracranial hypotension (iIH) when performed with the blind technique in the lateral decubitus position or fluoroscopic guidance in the prone position. We reviewed IH patients who underwent EBP between January 2015 and September 2019 in a single hospital and divided them into two groups according to the type of IH. Of the 84 included patients, 36 had sIH and 48 had iIH. We compared the effectiveness of EBP using the two methods in each group. There was no significant difference in the effect of EBP between the patients with iIH (p > 0.05). For patients with sIH, fluoroscopic guidance in the prone position technique showed better improvement than the blind technique in the lateral decubitus position (p < 0.05). We observed similar outcomes after blind EBP versus fluoroscopic guidance EBP in patients with iIH. However, procedure-dependent differences were observed in patients with sIH. For patients with sIH, it would be effective to consider fluoroscopic EBP first. Further study is needed to investigate interactions between method of EBP and other factors that affect the effectiveness of EBP.
硬膜外血贴（EBP）是治疗颅内低血压（IH）最有效的方法，可以采用侧卧位盲法或俯卧位透视引导下进行。本研究旨在比较采用侧卧位盲法或俯卧位透视引导下进行 EBP 治疗自发性 IH（sIH）和医源性 IH（iIH）患者的疗效。我们回顾性分析了 2015 年 1 月至 2019 年 9 月在我院接受 EBP 治疗的 IH 患者，并根据 IH 类型将其分为两组。84 例患者中，36 例为 sIH，48 例为 iIH。我们比较了两种方法在每组中的疗效。iIH 患者两种方法的 EBP 效果无显著差异（p>0.05）。对于 sIH 患者，俯卧位透视引导下的 EBP 效果优于侧卧位盲法（p<0.05）。我们观察到 iIH 患者中盲法 EBP 与透视引导 EBP 的结果相似。然而，在 sIH 患者中观察到与操作相关的差异。对于 sIH 患者，首先考虑透视 EBP 可能更有效。需要进一步研究以探讨 EBP 方法与影响 EBP 效果的其他因素之间的相互作用。
