Effectiveness of epidural blood patch in the management of post-dural puncture headache
Effectiveness of epidural blood patch in the management of post-dural puncture headache
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DOI：
10.1097/00000542-200108000-00012
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发表时间：
2001-08-01
期刊：
影响因子：
8.8
通讯作者：
Seebacher, J
中科院分区：
文献类型：
--
作者：
Safa-Tisseront, V;Thormann, F;Seebacher, J
研究背景腰硬外带血补片（EBP）是治疗硬脊膜穿刺后头痛的常用方法，但其疗效和作用机制仍存在争议。本研究的目的是评估EBP治疗严重硬膜穿刺后头痛的有效性和失败的预测因素。这项前瞻性观察性研究纳入了1988年至2000年在作者所在医院接受EBP治疗的所有因硬膜穿刺后头痛而失能的患者。EBP效应分为完全缓解（所有症状消失）、症状不完全缓解（临床改善，患者恢复到足以进行正常日常活动）和失败（严重症状持续）。采用Logistic回归分析以下数据以确定EBP失败的预测因素：（1）患者特征;（2）硬脑膜穿刺情况;（3）硬脑膜穿刺和EBP之间的延迟;（4）EBP注射的血量。EBP后症状完全缓解、不完全缓解和失败的发生率分别为75%（n = 377）、18%（n = 93）和7%（n = 34）。在多变量分析中，只有用于进行硬脑膜穿刺的针的直径（比值比= 5.96; 95%可信区间，2.63-13.47; P < 0.001）和EBP延迟小于4天（比值比= 2.63; 95%可信区间，1.06-6.51; P = 0.037）是EBP失败的独立显著危险因素。硬膜外血斑是治疗严重硬膜穿刺后头痛的有效方法。如果硬脑膜穿刺是由大口径针头造成的，则其有效性会降低。
Background Lumbar epidural blood patch (EBP) is a common treatment of post-dural puncture headache, but its effectiveness and mode of action remain a matter of debate. The aim of this study was to assess both the effectiveness and the predictive factors of failure of EBP on severe post-dural puncture headache.Methods. This prospective observational study includes all patients treated in the authors' hospital with EBP for incapacitating post-dural puncture headache, from 1988 to 2000. The EBP effect was classified into complete relief (disappearance of all symptoms), incomplete relief of symptoms (clinically improved patients who recovered sufficiently to perform normal daily activity), and failure (persistence of severe symptoms). The following data were analyzed using a logistic regression to identify predictive factors of failure of EBP: (1) patient characteristics; (2) circumstances of dural puncture; (3) delay between dural puncture and EBP; and (4) the volume of blood injected for EBP.Results: A total of 504 patients were analyzed. The frequency rates of complete relief, incomplete relief of symptoms, and failure after EBP were 75% (n = 377), 18% (n = 93), and 7% (n = 34), respectively. In a multivariate analysis, only the diameter of the needle used to perform dura mater puncture (odds ratio = 5.96; 95% confidence interval, 2.63-13.47; P < 0.001) and a delay in EBP less than 4 days (odds ratio = 2.63; 95% confidence interval, 1.06-6.51; P = 0.037) were independent significant risk factors for a failure of EBP.Conclusions. Epidural blood patch is an effective treatment of severe post-dural puncture headache. Its effectiveness is decreased if dura mater puncture is caused by a large bore needle.