產婦硬脊膜穿刺后頭痛的循證防治_《中國循證醫學雜志》

作者：

唐昱英 ,  林雪梅 , 黃蔚

四川大學華西第二醫院麻醉科（610041）;

關鍵詞：

硬脊膜穿刺后頭痛產婦循證防治

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目的　探討產婦硬脊膜穿刺后頭痛（PDPH）的循證預防治療措施。
方法　計算機檢索Cochrane圖書館（2006年第3期）、MEDLINE（1980.1～2006.10）和中國生物醫學文獻數據庫（1980.1～2006.10），收集關于產婦硬脊膜穿刺后頭痛防治的系統評價、Meta分析和臨床對照試驗（RCT），并評價所獲得的證據質量。
結果　共檢索到2篇Cochrane系統評價，2篇Meta分析和9篇RCT。分析結果表明，硬膜外自體血液填充治療療效確切，體位、液體和藥物治療對產婦PDPH的發生率和嚴重性無明顯影響。選擇適當腰麻穿針刺和穿刺技術能有效降低產婦PDPH的發生，而蛛網膜下腔注入生理鹽水和置管預防技術的價值尚有待進一步驗證。
結論　硬膜外自體血液填充對產婦的PDPH具有確切的治療作用, 選擇適當腰麻穿刺針和穿刺技術能有效預防產婦PDPH的發生。

引用本文： 唐昱英,林雪梅,黃蔚. 產婦硬脊膜穿刺后頭痛的循證防治. 中國循證醫學雜志, 2007, 07(3): 226-229. doi: 復制

1.	Choi PT, Galinski SE, Takeuchi L, et al. PDPH is a common complication of neuraxial blockade in parturients: a meta-analysis of obstetrical studies. Can J Anaesth, 2003, 50(5): 460–469.
2.	Naulty JS, Hertwig L, Hunt CO, et al. Influence of local anesthetic solution on postural puncture headache. Anesthesiology, 1990, 72(3): 450–454.
3.	Candido KD, Stevens RA. Post-dural puncture headache: pathophysiology, prevention and treatment. Best Practice & Research Clinical Anaesthesiology, 2003, 17(3): 451–469.
4.	Sudlow C, Warlow C. Posture and fluids for preventing post-dural puncture headache. Cochrane Database Syst Rev, 2002, 2:CD001790.
5.	Sudlow C, Warlow C. Epidural blood patching for preventing and treating post-dural puncture headache. The Cochrane Database of Systematic Reviews 2006 Issue 3.
6.	Richman JM, Joe EM, Cohen SR. Bevel direction and postdural puncture headache: a meta-analysis. Neurologist, 2006, 12(4): 224–228.
7.	Tejavanija S, Sithinamsuwan P, Sithinamsuwan N, et al. Comparison of prevalence of post-dural puncture headache between six hour- supine recumbence and early ambulation after lumbar puncture in thai patients: A randomized controlled study. J Med Assoc Thai, 2006, 89(6): 814–820.
8.	Abboud TK, Zhu J, Reyes A, et al. Effect of subarachnoid morphine on the incidence of spinal headache. Reg Anesth, 1992, 17(1): 34–36.
9.	Camann WR, Murray RS, Mushlin PS, et al. Effects of oral caffeine on post-dural puncture headache: a double-blind, placebo-controlled trial. Anaesthesia and analgesia, 1990, 70(2): 181–184.
10.	Sandesc D, Lupei MI, Sirbu C, et al. Conventional treatment or epidural blood patch for the treatment of different etiologies of post dural puncture headache. Acta Anaesthesiol Belg, 2005, 56(3): 265–269.
11.	Landau R, Ciliberto CF, Goodman SR, et al. Complications with 25-gauge and 27-gauge Whitacre needles during combined spinal-epidural analgesia in labor. International Journal of Obstetric Anesthesia, 2001, 10(3): 168–171.
12.	Douglas MJ, Ward ME, Campbell DC, et al. Factors involved in the incidence of post-dural puncture headache with the 25 gauge Whitacre needle for obstetric anesthesia. International Journal of Obstetric Anesthesia, 1997, 6(4): 220–223.
13.	Paech M, Banks S, Gurrin L. An audit of accidental dural puncture during epidural insertion of a Tuohy needle in obstetric patients.International Journal of Obstetric Anesthesia, 2001, 10(3): 162–167.
14.	Charsley MM, Abram SE. The injection of intrathecal normal saline reduces the severity of postdural puncture headache. Reg Anesth Pain Med, 2001, 26(4): 301–305.
15.	Sabry Ayad, Yousef Demian, Samer N, et al. Subarachnoid catheter placement after wet tap for analgesia in labor: influence on the risk of headache in obstetric patients. Regional Anesthesia and Pain Medicine, 2003, 28(6): 512–515.
16.	erger CW, Crosby ET, Grodecki W. North American survey of the management of dural puncture occurring during labour epidural analgesia. Can J Anaesth, 1998, 45(2): 110–114.
17.	Connelly NR, Parker RK, Rahimi A, et al. Sumatriptan in patients with postdural puncture headache. Headache, 2000, 40: 316–319.
18.	Paech M, Banks S, Gurrin L. An audit of accidental dural puncture during epidural insertion of a Tuohy needle in obstetric patients. International Journal of Obstetric Anesthesia, 2001, 10(3): 162–167.
19.	Wu YW, Hui YL, Tan PP. Experience of epidural blood patch for post-dural puncture headache. Acta Anaesthesiol Sin, 1994, 32(2): 137–140.
20.	Williams EJ, Beaulieu P, Fawcett WJ. Efficacy of epidural blood patch in the obstetric population. Int J Obstet Anesth, 1999, 8(2): 105–109.
21.	Pamela J. Angle, Kamal Hussain, Anwar Morgan, et al. High quality labour analgesia using small gauge epidural needles and catheters. Can J Anesth, 2006, 53(3): 263–267.
22.	Kuczkowski KM, Benumof JL. Decrease in the incidence of post-dural puncture headache: maintaining CSF volume. Acta Anaesthesiol Scand, 2003, 47(1): 98–100.
23.	Cohen S, Pollak P. Caudal saline infusion treatment for post dural puncture headache. Int J Obstet Anesth, 2001, 10(2): 149–150.

1. Choi PT, Galinski SE, Takeuchi L, et al. PDPH is a common complication of neuraxial blockade in parturients: a meta-analysis of obstetrical studies. Can J Anaesth, 2003, 50(5): 460–469.
2. Naulty JS, Hertwig L, Hunt CO, et al. Influence of local anesthetic solution on postural puncture headache. Anesthesiology, 1990, 72(3): 450–454.
3. Candido KD, Stevens RA. Post-dural puncture headache: pathophysiology, prevention and treatment. Best Practice & Research Clinical Anaesthesiology, 2003, 17(3): 451–469.
4. Sudlow C, Warlow C. Posture and fluids for preventing post-dural puncture headache. Cochrane Database Syst Rev, 2002, 2:CD001790.
5. Sudlow C, Warlow C. Epidural blood patching for preventing and treating post-dural puncture headache. The Cochrane Database of Systematic Reviews 2006 Issue 3.
6. Richman JM, Joe EM, Cohen SR. Bevel direction and postdural puncture headache: a meta-analysis. Neurologist, 2006, 12(4): 224–228.
7. Tejavanija S, Sithinamsuwan P, Sithinamsuwan N, et al. Comparison of prevalence of post-dural puncture headache between six hour- supine recumbence and early ambulation after lumbar puncture in thai patients: A randomized controlled study. J Med Assoc Thai, 2006, 89(6): 814–820.
8. Abboud TK, Zhu J, Reyes A, et al. Effect of subarachnoid morphine on the incidence of spinal headache. Reg Anesth, 1992, 17(1): 34–36.
9. Camann WR, Murray RS, Mushlin PS, et al. Effects of oral caffeine on post-dural puncture headache: a double-blind, placebo-controlled trial. Anaesthesia and analgesia, 1990, 70(2): 181–184.
10. Sandesc D, Lupei MI, Sirbu C, et al. Conventional treatment or epidural blood patch for the treatment of different etiologies of post dural puncture headache. Acta Anaesthesiol Belg, 2005, 56(3): 265–269.
11. Landau R, Ciliberto CF, Goodman SR, et al. Complications with 25-gauge and 27-gauge Whitacre needles during combined spinal-epidural analgesia in labor. International Journal of Obstetric Anesthesia, 2001, 10(3): 168–171.
12. Douglas MJ, Ward ME, Campbell DC, et al. Factors involved in the incidence of post-dural puncture headache with the 25 gauge Whitacre needle for obstetric anesthesia. International Journal of Obstetric Anesthesia, 1997, 6(4): 220–223.
13. Paech M, Banks S, Gurrin L. An audit of accidental dural puncture during epidural insertion of a Tuohy needle in obstetric patients.International Journal of Obstetric Anesthesia, 2001, 10(3): 162–167.
14. Charsley MM, Abram SE. The injection of intrathecal normal saline reduces the severity of postdural puncture headache. Reg Anesth Pain Med, 2001, 26(4): 301–305.
15. Sabry Ayad, Yousef Demian, Samer N, et al. Subarachnoid catheter placement after wet tap for analgesia in labor: influence on the risk of headache in obstetric patients. Regional Anesthesia and Pain Medicine, 2003, 28(6): 512–515.
16. erger CW, Crosby ET, Grodecki W. North American survey of the management of dural puncture occurring during labour epidural analgesia. Can J Anaesth, 1998, 45(2): 110–114.
17. Connelly NR, Parker RK, Rahimi A, et al. Sumatriptan in patients with postdural puncture headache. Headache, 2000, 40: 316–319.
18. Paech M, Banks S, Gurrin L. An audit of accidental dural puncture during epidural insertion of a Tuohy needle in obstetric patients. International Journal of Obstetric Anesthesia, 2001, 10(3): 162–167.
19. Wu YW, Hui YL, Tan PP. Experience of epidural blood patch for post-dural puncture headache. Acta Anaesthesiol Sin, 1994, 32(2): 137–140.
20. Williams EJ, Beaulieu P, Fawcett WJ. Efficacy of epidural blood patch in the obstetric population. Int J Obstet Anesth, 1999, 8(2): 105–109.
21. Pamela J. Angle, Kamal Hussain, Anwar Morgan, et al. High quality labour analgesia using small gauge epidural needles and catheters. Can J Anesth, 2006, 53(3): 263–267.
22. Kuczkowski KM, Benumof JL. Decrease in the incidence of post-dural puncture headache: maintaining CSF volume. Acta Anaesthesiol Scand, 2003, 47(1): 98–100.
23. Cohen S, Pollak P. Caudal saline infusion treatment for post dural puncture headache. Int J Obstet Anesth, 2001, 10(2): 149–150.

《中國循證醫學雜志》

產婦硬脊膜穿刺后頭痛的循證防治

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《中國循證醫學雜志》

產婦硬脊膜穿刺后頭痛的循證防治

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