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首页> 外文期刊>International journal of obstetric anesthesia >Ten years of experience with accidental dural puncture and post-dural puncture headache in a tertiary obstetric anaesthesia department.
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Ten years of experience with accidental dural puncture and post-dural puncture headache in a tertiary obstetric anaesthesia department.

机译：第三产科麻醉科在硬脑膜意外穿刺和硬脑膜穿刺后头痛方面的十年经验。

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BACKGROUND: Accidental dural puncture (ADP) and post-dural puncture headache (PDPH) are important complications of obstetric regional anaesthesia. METHODS: Between January 1997 and October 2006 in our tertiary obstetric referral centre 17 198 neuraxial blocks were recorded; 965 epidural, 16193 combined spinal-epidural and 40 spinal. Records of all parturients who experienced either ADP or PDPH were reviewed. RESULTS: There were 89 ADPs (0.5%), 55 observed and 34 in which PDPH followed unrecognised dural puncture. Following known ADP, 28 women had epidural catheters re-sited at a different lumbar interspace and 27 had intrathecal catheters for at least 24 h. Thirty-one women developed PDPH after observed ADP; the incidence of PDPH was similar after puncture with needle and catheter, after epidural and CSE techniques, after 27- and 29-gauge pencil-point spinal needles and after spinal and epidural catheter insertion (61% vs 52%; P>0.05). All headaches presented within 72 h. A blood patch was needed in 26/55 women after known ADP and 27/34 unrecognised ADP. A repeat blood patch was needed in 8 (15%). DISCUSSION: The incidence of ADP, PDPH, blood patching and repeat blood patching is similar to previous studies. Many ADPs are unrecognised during epidural insertion. CSE does not appear to increase the risk of ADP or PDPH; 29-gauge rather than 27-gauge pencil-point spinal needles conferred no benefit. Inserting the epidural catheter intrathecally did not significantly reduce the incidence of PDPH and blood patching in our series.
机译：背景：意外硬脑膜穿刺（ADP）和硬脑膜穿刺后头痛（PDPH）是产科区域麻醉的重要并发症。方法：1997年1月至2006年10月，在我们的第三产科转诊中心记录了17 198个神经阻滞。 965硬膜外，16193合并硬脊膜和40脊髓。回顾了所有经历过ADP或PDPH的产妇的记录。结果：共有89例ADP（0.5％），观察到55例和34例PDPH在无法识别的硬膜穿刺后进行。遵循已知的ADP，有28名妇女将硬膜外导管重新放置在不同的腰间隙，而27名妇女的鞘内导管至少持续了24 h。观察到ADP后有31名妇女发生PDPH。在使用针头和导管穿刺后，硬膜外和CSE技术，27号和29号铅笔尖的脊柱穿刺针以及插入脊柱和硬膜外导管后，PDPH的发生率相似（61％vs 52％; P> 0.05）。所有头痛均在72小时内出现。在已知ADP和27/34无法识别的ADP后，有26/55名女性需要补血。 8人（15％）需要重复补血。讨论：ADP，PDPH，补血和重复补血的发生率与以前的研究相似。硬膜外插入过程中无法识别许多ADP。 CSE似乎不会增加ADP或PDPH的风险; 29针而不是27针的铅笔尖脊柱针无益。在本系列中，鞘内插入硬膜外导管并不能显着降低PDPH和血液修补的发生率。

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