硬膜穿破后头痛的研究进展

硬膜穿破是硬膜外麻醉常见的并发症,可能导致阻滞平面过高甚至全脊麻.但是硬膜穿破后最常见的并发症是头痛,称为硬膜穿破后头痛(post-dural puncture headache,PDPHA).头痛的程度与患者的性别和年龄、穿刺针类型和粗细等因素相关.硬膜外血补片以及生理盐水注入是最常用也是最有效的治疗PDPHA的方法.     

硬膜外腔穿刺并发硬膜穿破的处理

硬膜穿破常并发穿破后头痛.现将我院5年来发生硬膜外麻醉穿破59例的原因和处理报告如下. 资料与方法 一般资料 1994年1月至1998年12月,我院共行硬膜外阻滞13692例,穿破59例,穿破率0.43%,其中男22例,女37例,年龄23～85岁,ASA均为Ⅰ～Ⅱ级.     

血栓阻塞硬膜外穿刺针致穿破硬膜1例

硬膜外麻醉穿刺过程中穿破硬膜的发生率在0．27％～0．6％之间，由于异物阻塞穿刺针而引发的更是罕见。近期我院发生因血栓阻塞穿刺针而并发穿破硬膜1例，现报告如下。     

持续硬膜外输注法用于硬膜穿破后的硬膜外阻滞

持续硬膜外输注法用于硬膜穿破后的硬膜外阻滞叶昭铨我院自１９９１年来遇有３例硬膜外阻滞穿破硬膜后，改换椎间隙重新穿刺置管，用微量泵持续输注法行硬膜外麻醉，获得满意效果。作者认为，用微量泵持续硬膜外输注给药法似有以下优点：１．微量泵持续输注法的单位时间内...     

硬膜外自家血充填疗法防治腰穿后头痛的体会(附12例报告)

我院自1968年至1984年共施行连续硬膜外麻醉15000人次,其中穿破硬膜12人次(0.08％)。采用硬膜外自家血充填法,防治刺破硬膜后并发头痛取得良好效果,现介绍如下。自家血液配制:以10ml注射器抽蒸溜水4ml。再抽自家血6ml,充分摇动,使红细胞溶解,避免血液凝固形成小的凝血块。     

硬膜外腔充填治疗硬脊膜穿破后头痛20例

因硬膜外麻醉时穿破硬脊膜,术后出现严重头痛,经临床输液、对症等治疗无效的20例病人在原穿刺点行硬膜外穿刺置管(导管保留1天).穿刺成功后硬膜外腔注入林格氏液30～35ml,平卧60分钟后嘱患者慢慢坐起,观察头痛是否缓解.     

硬膜外麻醉与镇痛并发神经功能障碍

硬膜外麻醉与镇痛可并发部分性或完全性感觉与运动神经功能障碍。主要问题有(1)硬膜穿破后头痛;(2)血肿压迫性瘫痪;(3)缺血性脊髓损害;(4)感染与损伤所致的神经后退症;(6)潜在性神经功能障碍在硬膜外麻醉后巧合性发作;(6)因误注或过量药物导致的严重补发症。     

硬脊膜穿破后头痛的预防和治疗

腰椎穿刺和硬脊膜外腔阻滞麻醉时意外穿破硬脊膜后,都可以发生与体位改变有关的头痛,目前文献上称为硬脊膜穿破后头痛(post-epidural puncture headache简称PEPH)与脊麻后头痛一样,是常见和麻烦的并发症,虽然多在一周左右自愈,或适当治疗后头痛消除,但也可长期不愈(1(1/2)～2年以上)。特别是硬脊膜外腔阻滞麻醉时意外穿破硬脊膜,头痛的发生率更高(70～75%)且症状严重。近些年来有关PEPH的研究取得新的进展,现就其原因,症状与治疗现状综述如下。 PEPH的原因一般认为PEPH有生理,心理和化学反应等多种因素引起。早在1902年Sicard发现腰椎穿刺后11天硬脊膜上仍有坏死穿孔区存在。1946年Franksson和Gradh用精巧的试验     

穿破硬脊膜后中分子右旋糖酐芬太尼复合液硬膜外腔填塞预防头痛

硬膜外麻醉穿刺操作中误穿破硬脊膜可致术后头痛。我们对不同硬膜外填塞方法对头痛的预防效果进行了比较。资料与方法一般资料　在 832 2例硬膜外麻醉中共穿破硬脊膜 51例 ,其中男 2 4例 ,女 2 7例 ,年龄 1 6～ 72岁 ,平均年龄 46±7 2岁 ,穿破位置最高Ｔ3～ 4,最低Ｌ2～ 3。填     

手术当日麻醉医师手术室管理决策的心理学基础

背景我们研究麻醉医师在没有提示的情况下，在预先安排好的时间和手术间里，是否倾向于做出使单位时间临床工作量增加的管理决策。尽管这种管理决策适用于单一手术间，但应用于多个手术间时，这种管理决策从经济学角度上看常常不理想。方法在一家医院进行两项研究：1）对通知单中的患者依次实施麻醉，麻醉医师按需做出管理决策，我们对此进行回顾性分析。2）研究接受管理方法教育前后，在夜间和周末时，麻醉医师做出的管理决策对患者和外科医师等待时间的影响。结果1）麻醉医师的决策使自己单位时间的工作量增加，但患者等待时间并没有减少。2）相反，夜间和周末的这些决策增加了患者和外科医师的等待时间。在教育麻醉医师用不同方法安排手术之后，这些决策并没有改变。结论本文的姊妹篇指出，麻醉医师随时随地可能做出使单位时间工作量增加的决策，即便这些决策会导致手术间过度使用、人员费用增高、工作时间不可预测和（或）强制性加班。目前的研究表明，提高工作速度的决策并不是为了减少外科医师和患者的等待时间。然而，在指定的手术间，麻醉医师的这些管理决策与增加单位时间的临床工作量是一致的。     

Post-dural puncture headache: pathophysiology, prevention and treatment

Post-dural puncture headache (PDPHA) has been a vexing problem for patients undergoing dural puncture for spinal anaesthesia, as a complication of epidural anaesthesia, and after diagnostic lumbar puncture since Bier reported the first case in 1898. This Chapter discusses the pathophysiology of low-pressure headache resulting from leakage of cerebrospinal fluid (CSF) from the subarachnoid to the epidural spaces. Clinical and laboratory research over the last 30 years has shown that use of small-gauge needles, particularly of the pencil-point design, is associated with a lower risk of PDPHA than traditional cutting point needle tips (Quincke-point needles). A careful history can rule out other causes of headache. A positional component of headache is the sine qua non of PDPHA. In high-risk patients (e.g. age < 50 years, post-partum, large-gauge-needle puncture), patients should be offered early (within 24-48 h of dural puncture) epidural blood patch. The optimum volume of blood has been shown to be 12-20 ml for adult patients. Complications of autologous epidural blood patch are rare.     

Effectiveness of epidural administration of saline solutions to prevent or treat postdural puncture headache

Epidural anesthesia is the most versatile and widely used of the techniques for regional anesthesia. The most common complication of epidural or spinal anesthesia is postdural puncture headache. The loss of cerebrospinal fluid through the hole can be an important causative factor of this cephalalgia. Of the many methods recommended for preventing and treating postdural puncture headache, one is bolus administration or infusion of saline solution into the epidural space, by which both epidural and subarachnoid pressures are increased. We have reviewed the literature evaluating the effectiveness of this technique from 1967 to 2004, using the following search terms: anesthesia, spinal; anesthesia, epidural; analgesia, epidural; headache; postdural puncture treatment or prophylaxis; epidural injection; epidural saline. Few articles were found. The studies had small samples and most did not include a control group. The doses and methods of epidural administration of saline solutions were highly variable and the results were often contradictory. We conclude that using this technique to prevent and/or treat postdural puncture headache is difficult to justify.     

Postdural puncture headache in obstetrics

Postdural puncture headache is the most common major complication following neuraxial anesthesia; this adverse event is particularly frequent in obstetrics. The headache is usually benign and self-limited but if left untreated can lead to more serious complications that may be life-threatening. Many treatments and prophylactic measures have been suggested, but evidence supporting them is scarce in many cases. After accidental dural puncture the only effective preventive measure is to leave the catheter inside the dura; epidural morphine infusion may also help. Once symptoms begin, treatment is conservative for the first 24 hours. If this approach fails, the most effective intervention continues to be a blood patch, which should not be delayed beyond 24 to 48 hours in order to avoid suffering. If more blood patches are required, other possible causes of headache should be ruled out.     

Inadvertent dural puncture during attempted thoracic epidural catheter placement complicated by cerebral and spinal subdural hematoma

Minor complications of inadvertent dural puncture during attempted epidural anesthesia are common, related to the size of the needle and the incidence of postdural puncture headache. Serious complications are much less common. We report a case where inadvertent dural puncture with an 18-gauge epidural needle was associated with the creation of intracranial and spinal subdural hematoma.     

Post-lumbar puncture headache as a complication of spinal anesthesia

Spinal anesthesia is a frequently used technique for surgery of the lower extremities. A complication of this form of regional anesthesia is post-lumbar puncture headache. Rapid diagnosis and treatment are essential in preventing prolonged disability and neurologic sequelae. Two case reports are presented, followed by a review of the literature concerning etiology, diagnosis, and treatment of post-lumbar puncture headache.     

A differential diagnosis for a postpartum headache

Headache is a common finding in the postpartum period. A wide variety of factors can contribute for its appearance and the causes include primary as well as secondary headache disorders. The postdural puncture is one of the most common headache causes in this context, but not the only one, which is why a differential diagnosis of postpartum headache is essential. We describe a patient with a headache in the immediate postpartum period. It was initially diagnosed as a common postdural puncture headache, but was later discovered to be a cervical hematoma.     

Postdural puncture: implications and complications

Postdural puncture headache is a distressing potential complication of spinal and epidural anesthesia. This article reviews the currently held thoughts on the topic, with a focus on the cause, prevention and treatment of postdural puncture headache.     

Neurocysticercosis: a new differential in the diagnosis of postdural puncture headache

IMPLICATIONS: Positional headache after spinal anesthesia is considered pathognomonic for postdural puncture headache. This report describes a patient who developed a positional headache after spinal anesthesia that was due to neurocysticercosis, a parasitic central nervous system infestation caused by the tapeworm Taenia solium.