Epidural blood patch for management of postdural puncture headache in adolescents
Epidural blood patch for management of postdural puncture headache in adolescents
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DOI：
10.1034/j.1399-6576.2002.460707.x
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发表时间：
2002-08-01
影响因子：
2.1
通讯作者：
Kokki, H
中科院分区：
文献类型：
--
作者：
Ylönen, P;Kokki, H
背景：在一些患者中，脊髓穿刺（SP）后出现硬膜穿刺后头痛（PDPH）。当PDPH的症状严重并且在几天内没有缓解时，可以进行硬膜外血液补片（EBP）。本调查的目的是回顾EBP的要求，并评估EBP在13-18岁的患者在6.5年的时间内（截至2001年6月）的有效性。方法：信息系统患者测量数据库进行了查询，以确定谁是EBP转诊的患者。结果：37例患者（男24例，女13例）共行EBP 42次，共完成40个SP。五名患者进行了两次硬膜外血斑治疗。再次手术的原因是3例患者使用新的PDPH重复SP，2例患者效果不满意。40例脊柱穿刺中有28例（70%）用于诊断，10例（25%）用于脊髓麻醉。两名患者（5%）在硬膜外穿刺针意外穿刺硬膜后发生PDPH。在37例病例中，符合PDPH的标准，1例患者出现脑脊液瘘头痛。三分之二的女孩有相关的头痛症状，而三分之一的男孩有。SP后1-22天行硬膜外血补片，硬膜外腔注入自体血0.2ml/kg（平均）。第一次注射的成功率为37 40 EBP（93%），和第二次注射是有效的复发PDPH.Conclusion患者：硬膜外血液补片似乎是一种有效和安全的程序在青少年治疗严重和持续PDPH。
Background: In some patients spinal puncture (SP) is followed by postdural puncture headache (PDPH). When the symptoms of PDPH are severe and are not relieved within a few days an epidural blood patch (EBP) might be performed. The aim of this survey was to review requests for EBPs and to evaluate the effectiveness of EBP in patients aged 13-18 years during a 6.5 year period ending in June 2001.Methods: The Information System Patient Measures Database was interrogated to identify patients who were referred for EBP. After identification, the patients' medical records were reviewed in detail for the characteristics of PDPH and other symptoms, and for the effectiveness of the EBP.Results: Forty-two EBPs were performed after 40 SPs on 37 patients (24 girls, 13 boys). Epidural blood patches were performed twice in five patients. The reasons for repeating the procedure were repeat SP with new PDPH in three patients and an unsatisfactory effect in two patients. Twenty-eight of the 40 spinal punctures (70%) had been performed for diagnostic use and 10 (25%) for spinal anesthesia. Two patients (5%) developed PDPH after inadvertent dural puncture with an epidural needle. In 37 cases the criteria for PDPH were fulfilled, and one patient had a cerebrospinal fluid fistula headache. Two-thirds of the girls had associated symptoms of headache compared with one-third of the boys. Epidural blood patch was performed 1-22 days after SP with 0.2 ml/kg (mean) of autologous blood injected into the epidural space. The success rate of the first injection was 37 out of 40 EBP (93%), and the second injection was effective in both patients with recurred PDPH.Conclusion: Epidural blood patch seems to be an effective and safe procedure in adolescents for treating severe and persistent PDPH.