Epidural blood patching for preventing and treating post-dural puncture headache.
Epidural blood patching for preventing and treating post-dural puncture headache.
复制标题
硬膜外血液修补用于预防和治疗硬膜穿刺后头痛。
DOI：
10.1002/14651858.cd001791
复制
发表时间：
2001
期刊：
影响因子：
--
通讯作者：
Charles Warlow
中科院分区：
文献类型：
--
作者：
C. Sudlow;Charles Warlow
背景
硬脑膜穿刺术是一种常见的手术方法，但脑脊液从由此产生的硬脑膜缺损处渗漏可能会在手术后引起体位性头痛，这可能是无效的。在缺损处周围注射硬膜外血块可以阻止这种渗漏，因此可能在预防或治疗硬膜穿刺术后头痛方面起到作用。
目标
目的：评价硬膜外补血在预防和治疗硬膜穿刺术后头痛中可能的益处和危害。
搜索策略
我们检索了Cochrane对照试验注册(Cochrane图书馆，2000年第4期)、MEDLINE(1994年1月至1998年12月)和EMBASE(1980年1月至1998年12月)。我们还搜索了通过电子方式确定的相关文章的参考清单，并要求所有纳入试验的作者和对这一领域感兴趣的同事让我们知道任何其他尚未确定的潜在相关研究。最后搜寻日期：2000年12月。
遴选标准
我们寻找了所有适当的随机、无混淆的试验，这些试验比较了硬膜外补血和非硬膜外补血在预防或治疗所有类型的因任何原因接受硬膜穿刺术的患者中硬膜穿刺术后头痛。有效性的主要结果是体位性头痛。
数据收集和分析
一位审查员从所有被认为符合纳入条件的试验的报告中摘录了试验方法和结果数据的细节。我们邀请所有这类试验的作者核实提取的信息，并提供已发表的报告中没有的任何细节。采用Peto O-E方法进行意向处理分析。还提取了有关不良反应的信息(硬膜穿刺术后腰痛、硬膜外感染和下肢感觉异常)。
主要成果
三项试验(77名患者)符合纳入条件。方法细节总体上是不完整的。尽管我们的分析结果表明，预防性和治疗性硬膜外补血都可能是有益的，但由于患者数量和结果事件非常少，以及试验方法学的不确定性，无法对这种干预的潜在好处和危害进行可靠的评估。
评审者的结论
此外，在就硬膜外补血在预防和治疗硬膜穿刺术后头痛中的作用得出可靠结论之前，需要进行足够有力的随机试验(包括至少几百名患者)。
BACKGROUND
Dural puncture is a common procedure, but leakage of CSF from the resulting dural defect may cause postural headache after the procedure, and this can be disabling. Injecting an epidural blood patch around the site of the defect may stop this leakage, and so may have a role in preventing or treating post dural puncture headache.
OBJECTIVES
To assess the possible benefits and harms of epidural blood patching in both the prevention and the treatment of post-dural puncture headache.
SEARCH STRATEGY
We searched the Cochrane Controlled Trials Register (Cochrane Library, Issue 4, 2000), MEDLINE (January 1994 to December 1998), and EMBASE (January 1980 to December 1998). We also searched the reference lists of relevant articles identified electronically, and asked both the authors of all included trials and colleagues with an interest in this area to let us know of any other potentially relevant studies not already identified. Date of last search: December 2000.
SELECTION CRITERIA
We sought all properly randomised, unconfounded trials that compared epidural blood patch versus no epidural blood patch in the prevention or treatment of post-dural puncture headache among all types of patients undergoing dural puncture for any reason. The primary outcome of effectiveness was postural headache.
DATA COLLECTION AND ANALYSIS
One reviewer extracted details of trial methodology and outcome data from the reports of all trials considered eligible for inclusion. We invited the authors of all such trials both to check the information extracted and to provide any details that were unavailable in the published reports. Intention-to-treat analyses were performed using the Peto O-E method. Information about adverse effects (post-dural puncture backache, epidural infection and lower limb paraesthesia) was also extracted.
MAIN RESULTS
Three trials (77 patients) were eligible for inclusion. Methodological details were generally incomplete. Although the results of our analyses suggested that both prophylactic and therapeutic epidural blood patching may be of benefit, the very small numbers of patients and outcome events, as well as uncertainties about trial methodology, precluded reliable assessments of the potential benefits and harms of this intervention.
REVIEWER'S CONCLUSIONS
Further, adequately powered, randomised trials (including at least a few hundred patients) are required before reliable conclusions can be drawn about the role of epidural blood patching in the prevention and treatment of post-dural puncture headache.
脊髓造影后头痛：回顾。
DOI：
10.1148/radiology.200.3.8756929
发表时间：
1996
期刊：
Radiology.
影响因子：
--
作者：
Peterman,SB
通讯作者：
Peterman,SB