产科人群意外硬脑膜穿刺后的持续性头痛和腰痛

2021-06-24 Sunny MedSci原创

意外硬膜穿刺是一种公认的用于分娩镇痛的硬膜外插入的并发症,据报道其发生率为1.2-2.6%。

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意外硬膜穿刺是一种公认的用于分娩镇痛的硬膜外插入的并发症,据报道其发生率为1.2-2.6%。硬膜穿刺和随后的颅内低血压可以激活三叉神经宫颈复合体,导致硬膜穿刺后头痛,对于这种情况,使用硬膜外血贴仍然是金标准管理

虽然硬膜外穿刺后头痛会导致短期内的巨大痛苦和发病率,但人们普遍认为这是一种自限性疾病,国际头痛协会对硬膜外穿刺后头痛的定义也反映了这种共识

然而,回顾性研究中出现的证据表明,意外的硬膜穿刺可能与持续的头痛有关。此外,有低质量的证据表明,意外硬膜穿刺和随后的硬膜外补血实际上可能增加新发腰痛的风险。

为了进一步研究这个问题,研究者进行了一项多中心、前瞻性匹配队列研究,以评估产科人群在硬膜外插入过程中发生意外硬膜穿刺后18个月的持续性头痛的发生率。研究者假设,在硬膜外穿刺过程中发生意外硬膜穿刺的妇女,其持续性头痛的发生率将明显高于硬膜外穿刺不顺利的妇女。

我们进行了一项前瞻性的多中心队列研究,评估了英国9个产科单位意外硬膜穿刺后持续性头痛的发生率。遭受意外硬膜穿刺的产妇与接受过顺利硬膜外穿刺的对照组进行了匹配。参与者每隔6个月接受一次随访,为期18个月。主要结果是18个月时持续头痛的发生率。90名意外硬膜穿刺的产科医生与180名对照组进行了匹配。256名(95%)参与者有完整的数据集可用于主要分析。

研究结果显示,意外穿刺组18个月时持续头痛的发生率为58.4%(52/89),对照组为17.4%(29/167),几率比(95%CI)为18.4(6.0-56.7),P<0.001,调整了过去的头痛史、医院焦虑和抑郁量表(抑郁)和医院焦虑和抑郁量表(焦虑)的分数后。意外穿刺组18个月时的腰痛发生率为48.3%(43/89),对照组为17.4%(29/167),几率比(95%CI)为4.14(2.11-8.13),经调整。

我们已经证明,意外硬膜穿刺与长期发病率有关,包括产科医生的持续头痛。这对目前将硬膜穿刺后头痛定义为自限性疾病提出了挑战,并提出了可能的临床、财务和法律后果。

原始出处:

Persistent headache and low back pain after accidental dural puncture in the obstetric population: a prospective, observational, multicentre cohort study.DOI:https://doi.org/10.1111/anae.15491

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