Echevarría M, Caba F, Olmedo L, Cruz A, Llamas J M, Rodríguez R
Servicio de Anestesiología y Reanimación, Hospital Universitario Virgen de Valme, Sevilla.
Rev Esp Anestesiol Reanim. 1994 Jul-Aug;41(4):217-20.
To compare the incidence of postdural puncture headache after subarachnoid anesthesia with a 24G Sprotte needle among full-term obstetric patients as compared to non-obstetric patients.
A total of 200 patients were studied prospectively, divided into 2 groups. Group 1 (n = 100) patients were delivered by cesarean section and group 2 (n = 100) patients underwent infraumbilical or traumatological surgery. All were ASA I-II and under 40 years of age. Hydration was accomplished with lactated Ringer's solution 400-1,000 ml before mid-line puncture. The anesthetic used in both groups was isobaric bupivacaine 0.5% with a vasoconstrictor. The incidence of arterial hypotension and accompanying symptoms was recorded; perioperative administration of vasoactive amines and anticholinergics and liquids administered was measured. Twenty-four to 48 hours later the patients were asked when they started walking and if postdural puncture headache was experienced.
Group 1 received smaller doses of bupivacaine (p < 0.05) and the incidence of arterial hypotension was greater (p < 0.01) and required increased administration of amines (p < 0.01) and perioperative fluid therapy (p < 0.001). No difference was found between the two groups either for time of start of ambulation or for incidence of headache, which was 1% in both groups.
The incidence of postdural puncture headache in obstetric patients is low and similar to that of non-obstetric patients when the 24G Sprotte needle is used.
比较足月产科患者与非产科患者蛛网膜下腔麻醉时使用24G斯普罗特针后发生硬膜穿刺后头痛的发生率。
前瞻性研究共纳入200例患者，分为两组。第1组（n = 100）患者行剖宫产，第2组（n = 100）患者接受脐下或创伤外科手术。所有患者均为ASA I-II级且年龄在40岁以下。在中线穿刺前，用400-1000ml乳酸林格氏液进行补液。两组均使用含血管收缩剂的0.5%等比重布比卡因。记录动脉低血压及伴随症状的发生率；测量围手术期血管活性胺、抗胆碱能药物的使用情况及液体输入量。24至48小时后询问患者开始行走的时间以及是否经历硬膜穿刺后头痛。
第1组接受的布比卡因剂量较小（p < 0.05），动脉低血压的发生率较高（p < 0.01），需要增加胺类药物的使用量（p < 0.01）和围手术期液体治疗量（p < 0.001）。两组在开始活动时间或头痛发生率方面均未发现差异，两组的头痛发生率均为1%。
使用24G斯普罗特针时，产科患者硬膜穿刺后头痛的发生率较低，与非产科患者相似。
