【罂粟摘要】产科人群中意外硬脊膜穿破后的持续性头痛和腰痛：一项前瞻性、观察性、多中心队列研究
产科人群中意外硬脊膜穿破后的持续性头痛和腰痛：一项前瞻性、观察性、多中心队列研究
贵州医科大学 高鸿教授课题组
翻译：吴学艳 编辑：佟睿 审校：曹莹
硬膜外穿刺意外硬脊膜穿破后可导致硬脊膜穿破后头疼，国际头痛学会将其定义为自限性头痛；研究目的旨在明确与对照产妇相比，意外硬膜穿破是否与持续性头痛和背痛相关。从而进行了一项前瞻性多中心队列研究，评估英国9个产科单位硬膜穿刺后持续性头痛的发生率。意外硬脊膜穿破的产妇与无硬脊膜穿破的对照组产妇相匹配，研究人员对参与者进行为期18个月的随访，每6个月一次；主要结果是观察18个月时持续性头痛的发生率。90例意外硬脊膜穿破的产妇与对照组180例无硬脊膜穿破的产妇中，共有256名(95%)参与者获得主要分析的完整数据。经校正头痛史、医院焦虑抑郁量表(抑郁)和医院焦虑抑郁量表(焦虑)得分后，18个月后意外硬脊膜穿破组持续头痛发生率为58.4%(52/89)，对照组持续头痛发生率为17.4%(29/167)，优势比(95%CI)为18.4 (6.0-56.7)，p < 0.001；术后18个月腰痛发生率为，意外硬脊膜穿破组48.3%(43/89)，对照组17.4%(29/167)，比值比(95%CI)为4.14(2.11-8.13)。本研究表明意外硬脊膜穿破与患者预后相关，包括产妇持续性头痛。这挑战了当前将硬脊膜穿破后头痛定义为自限性的定义，并提出了可能的临床、经济和法医学后果。
Niraj G, Mushambi M, Gauthama P, et al.Persistent headache and low back pain after accidental dural puncture in the obstetric population: a prospective, observational, multicentre cohort study.[J]Anaesthesia 2021 Apr 23.
Persistent headache and low back pain after accidental dural puncture in the obstetric population: a prospective, observational, multicentre cohort study
Summary
Accidental dural puncture following epidural insertion can cause a post-dural headache that is defined by the International Headache Society as self-limiting. We aimed to confirm if accidental dural puncture could be associated with persistent headache and back pain when compared with matched control parturients. We performed a prospective multicentre cohort study evaluating the incidence of persistent headache followingaccidental dural puncture at nine UK obstetric units. Parturients who sustained an accidental dural puncture were matched with controls who had undergone an uneventful epidural insertion. Participants were followedup at six-monthly intervals for 18 months.Primary outcome was the incidence of persistent headache at 18 months. Ninety parturients who had an accidental dural puncture were matched with 180 controls. The complete dataset for primary analysis was available for 256 (95%) participants. Incidence of persistent headache at 18 months was 58.4% (52/89) in the accidental puncture group and 17.4% (29/167) in the control group, odds ratio (95%CI) 18.4 (6.0–56.7), p < 0.001, after adjustment for past history of headache, Hospital Anxiety and Depression Scale (depression) and Hospital Anxiety and Depression Scale (anxiety) scores. Incidence of low back pain at 18 months was 48.3% (43/89) in the accidental puncture group and 17.4% (29/167) in the control group, odds ratio (95%CI) 4.14 (2.11–8.13), with adjustment. We have demonstrated that accidental dural puncture is associated with long-term morbidity including persistent headache in parturients. This challenges the current definition of post-dural puncture headache as a self-limiting condition and raises possible clinical,financial and medicolegal consequences.