Anaesthesia：产科患者意外硬脊膜穿刺后预防性与治疗性血补丁效果的对比
本帖最后由 南粤麻医 于 2014-3-22 12:36 编辑Prophylactic vs therapeutic blood patch for obstetric patients with accidental dural puncture – a randomised controlled trial
http://onlinelibrary.wiley.com/doi/10.1111/anae.12562/abstract
Summary
Epidural blood patch is a standard treatment for obstetric patients experiencing a severe post-dural puncture headache. Patients who sustained an accidental dural puncture during establishment of epidural analgesia during labour or at caesarean delivery were randomly assigned to receive a prophylactic epidural blood patch or conservative treatment with a therapeutic epidural blood patch if required. Eleven of 60 (18.3%) patients in the prophylactic epidural blood patch group developed a post-dural puncture headache compared with 39 of 49 (79.6%) in the therapeutic epidural blood patch group (p < 0.0001). A blood patch was performed in 36 (73.4%) of patients in the therapeutic group. The number of patients who needed a second blood patch did not differ significantly between the two groups: 6 (10.0%) for prophylactic epidural blood patch and 4 (11.1%) for therapeutic epidural blood patch. We conclude that prophylactic epidural blood patch is an effective method to reduce the development of post-dural puncture headache in obstetric patients.
硬膜外血补丁治疗是产妇硬脊膜穿刺后严重头疼的标准治疗方法，本研究纳入分娩镇痛或剖宫产时硬膜外意外穿刺的患者，随机接受预防性硬膜外血补丁治疗或仅在需要时行血补丁治疗。预防组的头疼发生率为11/60（18.3%）；而治疗组为39/49（79.6%），有明显差异。治疗组血补丁为73.4%。两组间需要再次血补丁治疗的患者数无统计学意义。
结论认为，预防性血补丁治疗可有效预防产科患者硬脊膜意外穿刺后头疼的发生。 Morgan and Mikhail's Clinical Anesthesiology上关于血补丁的内容，不推荐预防性使用血补丁，因为并非所有患者都会出现穿刺后头痛（只有25-50%患者出现头痛）。也不推荐经硬膜外导管注射血补丁，因为导管头端可能远离硬脊膜穿刺点。
血补丁方法：一般在采取12-24h的保守治疗效果不佳时采取血补丁治疗。在原穿刺间隙或低一间隙注射15-20ml自体血，90%患者有效，首次注射无效的患者再次血补丁治疗有效率为90%。
国外大学非常重视的患者健康教育内容中也有血补丁的相关内容：
http://www.uwhealth.org/healthfacts/pain/6098.html
http://www.patient.co.uk/health/ ... -spinal-anaesthetic
http://www.urmc.rochester.edu/im ... epidural-patch.aspx
Pubmed上关于Epidural blood patch的内容：
http://www.ncbi.nlm.nih.gov/pubmed/?term=Epidural+blood+patch http://v.youku.com/v_show/id_XMzcyOTE4NDg4.html 治疗性血补丁,是在硬膜外注射自体血吗？有全文发一个 Paediatr Anaesth. 2014 Mar;24(3):345-7. doi: 10.1111/pan.12324.
Epidural blood patch relieves positional diplopia following lumbar punctures.
Mills R1, Radhakrishnan R, Moore DL, Sadhasivam S.
http://www.ncbi.nlm.nih.gov/pubmed/24467576 假如穿刺位置不当，容易引起神经根症状，所以穿刺很关键 椎管内麻醉的神经并发症还是以预防为主，个人观点 如果出现了，真的让人头痛。 血补丁会引起硬膜外血肿吗
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